The past few years have been a life-changing experience for me and this work would not have been possible without the help and support of many people. First and foremost, I would like to thank God Almighty for giving me the power and strength to pursue my dreams.
I would like to express my special thanks and appreciations to my great supervisor Dr Luca Marciani, thank you for your guidance, support and for the invaluable advices. Thanks for giving me the skills that improved me and for encouraging me to grow as a researcher. Without your kind words and motivations, I would not have had the confidence to excel academically.
I would like to express my sincere thanks for the support throughout this project, the constructive suggestions, and the critical advices of my co-supervisor Dr Gordon Moran. I also would like to acknowledge the constant guidance and valuable input of Prof Penny Gowland. A very special thanks to Dr Caroline Hoad, thank you for teaching me various methods and techniques and for answering all my questions no matter how busy you were.
I would like to express my sincere gratitude to all those at the Biomedical Research Centre (BRC), Sir Peter’s Mansfield Imaging Centre (SPMIC), and the Medical physics department who helped me throughout my studies. I gratefully acknowledge the funding received towards my PhD from Kuwait University. I also greatly appreciate the financial support received for the study in chapter 5 from Kuwait Foundation for the Advancement of Sciences (KFAS) under project code CB17-63NR-01.
To my family, I express my gratitude for the support through good and bad times. A heartfelt thank you to my Mum, without your prayer for me I would not have come this far. To my beloved son and daughter, thank you for always listening and cheering me up! I’m thankful to my sister, for unconditionally loving me and for always being there for me. My acknowledgement would be incomplete without thanking my best friends. Thank you, my friends, for the unconditional friendship, for the motivations, for believing in me, and for being by my side throughout this PhD.
Introduction: Crohn’s disease patients suffer postprandial symptoms such as chronic diarrhoea, abdominal pain, bloating, weight loss and nutritional abnormalities. The changes in the regulation of gut hormones and gut dysmotility are believed to play a role but these are rarely studied together in the postprandial state in an unprepared bowel. This project aimed to use MRI to investigate the peptide and small bowel motility pathophysiological postprandial responses in CD.
Methods: Sixteen CD patients with active disease (age 36±3 years, BMI 26±1 kg/m2) and 20 healthy volunteers (age 31±3 years, BMI 24±1 kg/m2) participated. They underwent baseline and postprandial MRI scans, symptom questionnaires, and blood sampling at intervals for 270 minutes following a 400 g soup meal (204 kcal). Gastric volume, gall bladder volume, small bowel water content, small bowel motility, whole gut transit, GLP-1, PYY, and CCK were measured. A new processing technique was developed and used to quantify small bowel motility from cine MRI data. A standard magnetic resonance enterography (MRE) test was also performed at the end of the feeding study to measure disease activity. An assessment of gastric emptying of the soup meal by MRI and gamma scintigraphy (GS) was also carried out.
Key results: (mean±SEM) The healthy volunteers had significantly higher fasting motility index (106±13 a.u.) compared to CD subjects (70±8 a.u., p