Southampton Academy of Research

Dr Tracy Coelho is a Consultant in Paediatric Gastroenterology at University Hospital Southampton (UHS) and holder of a Research Leaders Programme (RLP) award.

His research focuses on improving care for children with inflammatory bowel disease (IBD).

Helping children with IBD

IBD can affect people of any age, including children. It can cause symptoms such as tummy pain, diarrhoea and blood in their poo. It can also mean they struggle to grow or feel tired all the time.

“All these symptoms can make them very poorly, and not able to attend school,” explains Tracy.

“They may have obstruction of the bowel, they might not be able to tolerate any food, so often they have to come to hospital as an emergency.”

In children with IBD, the immune system attacks the gut, causing it to become inflamed and sore. The two main types are Crohn’s Disease and Ulcerative Colitis.

It is a long-term condition, with symptoms coming and going throughout the patient’s life. When their symptoms get worse, it is known as a flare-up. When they are better, the patient is said to be in remission. There is currently no cure.

Avoiding the need for surgery

In the past, many children underwent surgery to remove the part of the bowel that was most inflamed. However, it is now often possible to treat their condition using medicines alone.

Tracy will use his RLP award to investigate whether two different types of medicine – small molecule drugs and biologics – can help more children with IBD avoid the need for surgery.

This will include trials, including commercial trials, to see if drugs shown to be effective in adults with IBD can also help children. He also plans to use his time to develop new collaborations and supervise medical students.

“The RLP provides me with dedicated research time,” he says. “This means I can take on more projects, supervise others and develop my academic profile.”

Tailoring treatment

The most commonly used medicines for IBD ‘suppress’ or dampen down the activity of the child’s immune system, to prevent it from attacking their gut.

These can help some patients, but are not effective for everyone and may cause serious side effects.

“We now have better treatments, especially biologics, which have actually made a huge difference to patients over the last few years,” Tracy explains. “But not all patients respond, and some patients react quite severely.”

During his PhD, which he completed in 2019, Tracy investigated the immunology and genetics of paediatric IBD. He now hopes to use his knowledge and expertise in this area to benefit patients.

He has since set up a new GI-Genomics clinic for children under six, which aims to see if their IBD is caused by a single gene. This means he is now able to use his research to improve care for his patients.

Through his RLP research, Tracy now aims to use information from their DNA to predict which drugs will work for which patients, and who is most likely to experience side effects.

“Most of the drugs used in IBD are immunosuppressive medications. How patients respond to these, in terms of therapeutic effect and side effects, varies from patient to patient,” says Tracy.

“I am therefore trying to tailor the medications we give to patients, based on their individual genomic profiles.”