Synopsis
Beyond the obvious bias of a passionate gastroenterologist, evolution suggests that the gastrointestinal (GI) tract may have been the master organ of the body, with its huge armamentarium of functions and the fact it contains one of the most prolific nerve networks of the body, the so-called Enteric Nervous System or ENS. This Grand Round will address key concepts around the ENS. Not only does it play a central role in coordinating the contractile apparatus of the gut but also in the complex interplay between its luminal contents, the vast and enigmatic microbiome, its robust immune system and the central nervous system. Pre and post-natal gut development comes at the potential cost of increased vulnerability to insult, giving rise to early life programming of the ENS as a mechanism of disease
The management of the most severe disorders of the ENS remains fraught and disappointing but the last decade has seen real progress in the potential of regenerative medicine and tissue engineering. Challenges remain in elucidating the precise nature of ENS defects, the knowledge of which will be essential to develop effective treatments. For the first time we see the real prospect of not only understanding the normal or abnormal development and programming but also curative repair of the ‘second’ or perhaps, more correctly the ‘first brain’ of the human body.
Speaker
Dr Nikhil Thapar is Academic Lead, Senior Lecturer (University College London Institute of Child Health) and honorary consultant (Great Ormond Street Hospital for Children) for Paediatric Gastroenterology. He runs a specialist multidisciplinary clinical service for children with gastrointestinal motility and functional disorders including a national (UK) service for children with intestinal pseudo-obstruction. Dr Thapar’s research programme focuses on the pathogenesis and treatment of gut motility disorders including molecular mechanisms and regenerative medicine. He sits on the council of European Society of Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) as chair of the gastroenterology committee and chairs the British Society’s gut motility disorders working group. Dr Thapar is the executive director of the Academy of Paediatric Gastroenterology and lead for the ESPGHAN young investigators forum. Dr Thapar is co-editor of the textbook of Paediatric Neurogastroenterology.