| Research
Oesophageal Cancer
Upper gastrointestinal cancer surgery is a major specialty interest of the department accounting for a significant proportion of the clinical workload at St. James Hospital. There has been an alarming increase in the incidence of adenocarcinoma of the oesophagus over the past 20 years in Western populations. Whilst the aetiology of oesophageal cancer remains largely undetermined there has been increasing interest in the role of reflux oesophagitis as a risk factor in its pathogenesis. Ongoing research in the department is focusing on the expression of inflammatory markers in reflux.
Immunological Response to Surgical Trauma
The body’s immune response to major illness and surgical trauma has become recognised as a major challenge to surgeons over the last century. The mechanisms and pathways leading to the Systemic Immune Response Syndrome (SIRS) remain far from understood. A failure of the gut mucosal barrier to exclude bacteria and endotoxin from the portal and systemic circulation is incriminated in the development of sepsis and multiple organ failure. Although the experimental data is compelling, corroborative evidence from studies in humans is sparse. The department is involved in ongoing research into the role of the gut and portal circulation in the development of immune dysfunction post-operatively.
Upper GI Physiology
The department has a long established interest in Gastrointestinal Physiology. Techniques such as Oesophageal Manometry, Ambulatory 24 hour Manometry, 24 hour pH monitoring, Bile Monitoring and Electrogastrography continue to be used to investigate patients with gastro-oesophageal reflux disease (GORD). Physiology studies in Barrett’s Oesophagus have investigated the role of gastro-duodenal reflux in the aetiology of this disease. Extrinsic pathology influencing oesophageal function has been extensively investigated including biliary, respiratory and cardiac models. Research on the role of the lower oesophageal sphincter in Achalasia and GORD is ongoing. The recent introduction of new endoscopic anti-reflux techniques has seen a resurgence of interest in GI Physiology.
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