Ailsa Hart is Consultant Gastroenterologist at St Mark’s Hospital and Past Dean of St Mark’s Hospital Academic Institute. In 2016, she achieved academic promotion at Imperial College London, UK, and is now Professor of Practice, making her among the youngest females to achieve this award at Imperial College. She has contributed to the IBD Clinical Research Group Committee for the British Society of Gastroenterology (BSG) and is past Chair of the Gut Microbiota for Health Group of the BSG. She is the UK Patient and Public Involvement Lead for Gastroenterology and is on the Research Committee for the Crohn’s and Colitis UK charity. She was the UK Patient and Public Involvement Lead for Gastroenterology and is on the Research Committee for the Crohn’s and Colitis UK charity. She has contributed to the Committees and Governing Board of ECCO for over 10 years. She is a member of the International Organization for the Study of Inflammatory Bowel Disease (IOIBD).

What attracted you to a career in gastroenterology/hepatology?

I have several doctors in my family – in fact I am the third generation of Dr Harts; my mother was a doctor and also my grandfather. So, I suppose when I was growing up, I was surrounded by doctors and inspired by medicine. When I was a medical student at Oxford University, I was taught by Professor Derek Jewell, and then was his House Officer in 1995. It was during this time that I met some of his research fellows, including Miles Parkes, who was genuinely an inspiration, and a lot of fun! So, my interest in gastroenterology, and particularly in IBD, stemmed from this early time in my career. After this my first Senior House Officer job in 1996 was at St Mark’s Hospital, just after the hospital moved to the Northwick Park site, and I worked for Professor Michael Kamm, who was an incredible support, gave me lots of opportunities and encouraged me to do my PhD with Imperial College on immunology, in particular dendritic cell function, and the influence of the microbiota in IBD. After this I was hooked….

What advancement in gastroenterology/hepatology are you most excited about and why?

In IBD, they are many evolutions in research which have advanced the field, but occasionally there are revolutions that really make a step change in how we practice and manage our IBD patients. For me, the PROFILE study, which has been led by the group from Cambridge, is some of the most inspirational work which has revolutionised the field.  Although this study had aimed to find a biomarker to help us predict the course of disease over time (unfortunately this was not proven), what the study has resoundingly achieved is a clear focus on the improved patient outcomes that can be achieved if we treat optimally very early after a patient is diagnosed with Crohn’s disease. What is needed now is support from policy makers to enable a higher priority for IBD patients and development of pathways to have faster time to diagnosis so that we can truly make an impact for IBD patients.

From my own personal research perspective, I think some of the work I'm most interested in is a potential biomarker for colorectal cancer for IBD patients who are undergoing colonoscopic surveillance. IBD patients have an approximately 2x increased risk of developing colorectal cancer and for this reason they participate in a cancer screening or surveillance programme after around 8 years from symptom onset. These colonoscopies aim to identify precancerous changes – and if these changes are found patients are offered surgery (which is a life-changing operation – sometimes a pouch and sometimes a permanent stoma) or ongoing close surveillance, depending on the level of predicted risk. The problem is that we are very poor at predicting this risk based on clinical indices such as the size, shape, resectability and multifocality of the lesion(s). However, work with Professor Trevor Graham, who is an exceptional scientist whom I have worked with for the last 15 years, has found that a genomic marker, which assesses the burden of DNA copy number alterations, is around 90% accurate in predicting patients who go on to develop high grade dysplasia or cancer. The challenge now will be to see if it is possible to translate this into a remote means (blood or stool) of monitoring patients to streamline surveillance strategies and hopefully make them smarter in the coming years. I think this is a very exciting prospect.

The other area of research  which I'm excited about is an increasing emphasis on the holistic care of the IBD patient - so not just trying to treat the inflammation as well as we can with the increasing medical options, but really focusing on their mental health, and addressing difficult and life-limiting symptoms, like fatigue, pain and urgency, which are often residual even when inflammation is controlled. I've had the pleasure of working with Professor Christine Norton for the last 10 years and we have completed a programme grant called IBD BOOST, which is opening the doors to using psychological interventions to treat patients who have these difficult symptoms. This in addition to developing the IBD psychology unit at St Mark’s with a wonderful team has been incredibly rewarding.

The final area of research I would like to mention is perianal Crohn’s disease (pCD). I am incredibly proud of the achievement of setting up, with my fantastic surgical colleague Phil Tozer, a global consortium, called TOpClass (Treatment Optimisation and Classification of pCD). This group of individuals from around the world has developed a new classification for pCD and pathways to optimise time to diagnosis and treatment and is now working on synchronising standard ways of collecting samples and data across the world so that we can move the pace of research on the pathogenesis and treatment of this difficult phenotype of Crohn’s disease.

What do you enjoy most about your work?

So, I enjoy interacting with the patients, and I am also very fortunate to have exceptional colleagues whom I interact with in my day-to-day work; excellent surgeons, dieticians, nurses, amazing scientists, research fellows and a brilliant secretary. I can honestly say that I feel particularly inspired by the patients I treat. I also love joint clinic working - for example, the medical/surgical clinics, and the transition/young person’s clinic, where we really see the benefit for patients when they have to be assisted in making difficult decisions. This is where, for me, the art of medicine and good communication really comes together with the science of medicine that we are all striving to understand better.

What is the one thing you would change?

A standout thing that I would change would be the administrative burden that we as consultants have to face now which deflects time away from patient management and research. It is truly crippling, unsafe for patients and a retrograde step in my opinion.

What’s the best advice you’ve been given in your career?

I think that's probably changed over my career. For example, early on in my career, I was advised (and I think that it was good advice at the time) to accept any offers that came along, to get involved in initiatives in research, and I definitely said “yes” to a lot of opportunities which gave me a great springboard. But as time has gone by, I think the best advice is to be more focused and actually say “no” to quite a few things. That has certainly helped me to become more focused on key areas in IBD which I want to be my area of expertise. I think the other important piece of advice early on was to invest research energy in the area where there is a more unique chance of making a difference. For me, at St Mark’s Hospital, with its excellent IBD surgical expertise, this was perianal CD, cancer surveillance and pouch research. I think the other really good career advice I've had has been to surround myself with excellent people, not just within the hospital, but also nationally and internationally - it's an incredibly enriching opportunity that we have across the globe to link with likeminded people.

What does being a BSG member mean to you?

So, I think this is a an easy one to for me to answer because it's the community. It's the spirit and camaraderie that being part of a community of likeminded people who all share the same challenges offers. I think that's what the BSG has done and continues to do for me.