Dr Richard Felwick is a Consultant Gastroenterologist at University Hospital Southampton (UHS) and part of the Research Leaders Programme.

His research focuses on improving care for adults with Inflammatory Bowel Disease (IBD).

An invisible disease

IBD is a group of conditions that cause the gut to become inflamed. The most common types are ulcerative colitis and Crohn’s disease. It affects more than half a million people in the UK.

People with IBD can experience severe pain, diarrhoea and fatigue. It often comes and goes, getting worse during ‘flare-ups’ or better when it’s well controlled and ‘in remission’.

It can affect people at any age, but often starts when people are in the prime of their life, in their twenties, thirties or forties. This means they may be trying to study, work or look after children, while in pain, tired all the time, or needing to go to the toilet ten times a day.

“They’re common conditions, they affect a lot of people, but they’re often quite hidden. People can have really severe disease, but it’s not visible,” Richard explains.

“Because it’s not visible, people look at you and think ‘there’s nothing wrong with you, you look okay, you’re fine’, but actually they’re really suffering.”

People with IBD usually have it for life. While there are medicines available that can keep it under control, these do not work for everyone, and the effects can wear off over time.

Research has helped improve our understanding of the disease. We know it involves a combination of genetics, diet and the bacteria naturally found in our gut, and an abnormal immune response. However, Richard says there’s still a lot left to discover.

“We don’t know fully what causes it,” he says. “We don’t know what triggers a flare, and we don’t really know who’s going to respond to medications and who’s not going to respond.”

Combining clinical and laboratory research

Richard has long been involved in research. During his clinical training, he worked as a Clinical Fellow with Dr Fraser Cummings, recruiting patients to clinical trials.

“That was really good, because I saw patients where we had no other options for them, but could offer them a drug in the context of a clinical trial,” he says. “You don’t know if they’re getting the drug or placebo, but some people got better. It really turned things around for them.”

Alongside this, he did a laboratory-based PhD with Dr Jane Collins, which continued after his Clinical Fellow job ended. This involved collecting biopsy samples from patients with Crohn’s disease. He used these to investigate the effect of the immune system on the lining of the gut.

In 2018, he became a consultant. Since then, he’s been ‘dabbling’ in research, but hasn’t had the time to properly focus on his ideas and develop them. He hopes the RLP will change this.

“I’ve always enjoyed research,” he says. “I really enjoyed my lab-based PhD, and was heavily involved in research up until my consultant job. I’d like it to be a more permanent part of my job.”

Creating a research platform

The IBD at UHS team look after around 6500 patients. Almost all of them have at least one endoscopy at some point during their care, either for diagnosis, assessment of treatment effect or surveillance. This involves inserting a long, thin tube with a small camera inside, called an endoscope, to look inside their gut.

Endoscopies can also be used to take a biopsy - a small sample of tissue from their gut. Patients could therefore be asked before the procedure if they would be happy for a biopsy to be taken for research purposes.

One of Richard’s goals for his RLP is to set up a platform where researchers or companies could access these biopsy samples. These could then be used for laboratory research, to understand the disease better or develop new treatments.

“People collect samples for a defined project and then move on,” he says. “But we’ve got a huge resource here. The idea is that we can collaborate, providing clinical insight to help inform and develop the basic translational science. The aim is to create a platform that’s free to use, where we provide the samples they need and develop a more consistent programme of research.

“A real strength of our cohort is that they are clinically characterised. So instead of just providing a tissue biopsy or blood sample, we know how long they have had their IBD for, what treatments they have had and in what sequence. That is really powerful information, and allows us to interpret that sample result in a more meaningful way.”

This will involve forming a network of collaborators. He says the RLP will give him the time, support and skills to do this.

“I just need the time and the space to develop the platform, as well as getting the skills to lead research. I want to build a network we can all benefit from. It’s about having the time and support to do that, which I think the RLP offers.”