Charles Knowles

Charles Knowles

Title: Professor
MBBChir, PhD, FRCS, FRCS (Gen Surg)
Clinical Professor of Surgical Research, Head of Academic Surgical Unit

Prof Knowles' main clinical interests are in the surgical management of benign coloproctological conditions and severe motility disorders including the use of neurostimulation. His main research interests are:

  • the patho-aetiology of gastrointestinal neuromuscular diseases;
  • the molecular basis of gut sensorimotor dysfunction, particularly in relation to abdominal pain;
  • the role of colorectal physiological tests in guiding therapy in conditions such as constipation and faecal incontinence (especially focusing on neuromodulation).

Prof Knowles is a Fellow of the Royal College of Surgeons of England, Co-director of the National Centre for Bowel Research and Surgical Innovation, Chairman of the Whitechapel Society for Gastroenterological Research, Research lead of the Neurogastroenterology Section of the British Society of Gastroenterology, Deputy Clinical Director of the NHS Bowel Healthcare Technology Cooperative and Chair of the GI neuromuscular pathology international working group. He is the author of over 80 peer reviewed publications and five books.

Bio

Prof Knowles undertook his preclinical training at Cambridge University and then moved to the London Hospital Medical College, qualifying in 1992. Prior to specialist training, he undertook research based at Barts & the London and, funded by the Royal College of Surgeons of England, leading to the degree of PhD at the University of London in 2000. He entered the Specialist Register in 2005 as a general and colorectal surgeon. In 2006, he was appointed Senior Lecturer in Colorectal Surgery on the basis of a prestigious award from HEFCE. He holds an Honorary Consultant appointment at Barts Health NHS Trust.

Research

Overview

  • The use of advanced colorectal physiology to guide surgical treatment, in particular the evolving use of neuromodulation
  • Cellular and molecular basis of peripheral visceral afferent function particularly in relation to visceral pain, using both in vivo and in vitro human models
  • Characterisation of the neuropathology and aetiology of severe primary and secondary gastrointestinal neuromuscular disease
  • Neuromuscular pathological aspects of gastrointestinal motility disorders
  • The molecular basis of gut sensorimotor dysfunction, particularly in relation to visceral hypersensitivity and pain
  • The role of autoantibody-mediated disease in gut motility disorders
  • The role of clinical tests of colorectal physiology in guiding therapy

Recent and ongoing research projects

  • Development of the first international classification of GI neuromuscular pathology
  • Prospective randomized double-blind study of sacral nerve stimulation in patients with rectal evacuatory dysfunction and rectal hyposensitivity
  • In vitro human visceral afferent recordings
  • A randomised mixed methods pilot (phase II exploratory trial) of sacral and percutaneous tibial nerve stimulation for faecal incontinence (NIHR RfPb)
  • CONtrol of Faecal Incontinence using Distal NeuromodulaTion (CONFIDeNT) study (NIHR HTA)
  • GI neuromuscular disease international database
  • Study of central afferent neural mechanisms of sacral nerve stimulation
  • Pilot randomised study of ambulatory transcutaneous tibial nerve stimulation for overactive bladder and faecal incontinence
  • IMmediate Pharmacological intervention in Acute Colonic pseudo-obstrucTION (IMPACTION) – randomised trial of single dose 2mg prucalopride
  • Development of a UK evidence-based algorithm for management of chronic constipation (NIHR PDG)
  • Selective nerve stimulation for chronic abdominal pain

Publications

Peiris M, Bulmer D, Baker M, Boundouki G, Sinha S, Hobson A, Lee K, Aziz Q, Knowles CH. Human visceral afferent recordings: preliminary report. Gut 2011; 60: 204-8.

Knowles CH, Thin N, Gill K, Bhan C, Grimmer K, Lunniss PJ, Williams NS, Scott M. Prospective randomized double-blind study of sacral nerve stimulation in patients with rectal evacuatory dysfunction and rectal hyposensitivity. In press: Ann Surg July 2011.

Knowles CH, De Giorgio R, Kapur RP, Bruder E, Farrugia G, Geboes K, Gershon MD, Hutson J, Lindberg G, Martin JE, Meier-Ruge WA, Milla PJ, Smith VV, Vandervinden JM, Veress B, Wedel T. The London Classification of GI Neuromuscular disease. Gut 2010; 59: 882-887.

Knowles CH, Aziz Q. Basic and clinical aspects of gastrointestinal pain. Pain 2009; 141: 191-209.

Nastro P, Knowles CH, McGrath A, Heyman B, Porrett TR, Lunniss PJ. Complications of intestinal stomas. Br J Surg. 2010; 97: 1185-9.

Knowles CH, De Giorgio R, Kapur RP, Bruder E, Farrugia G, Geboes K, Gershon MD, Hutson J, Lindberg G, Martin JE, Meier-Ruge WA, Milla PJ, Smith VV, Vandervinden JM, Veress B, Wedel T. Gastrointestinal neuromuscular pathology: guidelines for histological techniques and reporting on behalf of the Gastro 2009 International Working Group. Acta Neuropathol 2009; 118: 271-301.

Martin JE, Hester TW, Aslam H, Sinha S, Knowles CH. Discordant practice and limited histopathological assessment in gastrointestinal neuromuscular disease. Gut 2009; 58: 1703-5.

Hubball A, Lang B, De Giorgio R, Martin JE, Knowles CH. The role of humoral autoimmunity in Gastrointestinal neuromuscular disease. Prog Neurobiol 2008; 87: 10-20.

Gooneratne M, Facer P, Knowles CH, Frye J, Chan C, Anand P, Williams NS. Elevated rectal mucosal substance P levels in patients with faecal incontinence are normalised by successful sacral nerve stimulation. Br J Surg 2008; 95: 477-83.

Knowles CH, Veress B, Tornblom H, Wallace S, Paraskevas P, Darzi A, Martin JE, Nyborg B, Lindberg G. Safety and diagnostic yield of laparoscopically assisted full-thickness bowel biospy. Neurogastroenterol Motil 2008; 20: 774-9.

Williams NS, Murphy J, Knowles CH. The Anterior Perineal PlanE for ultra low Anterior Resection (the APPEAR technique): a pilot study. Ann Surg 2008; 247: 750-758.


View all Charles Knowles's Research Publications at: http://www.researchpublications.qmul.ac.uk

Teaching

  • Lecturer on the final MB revision and preparation for practice courses: Barts & the London SMD
  • Lecturer on MSc, Intercalculated BSc and higher surgical training courses locally and internationally
  • Lecturer on Cass University (nursing) coloproctology masterclass course
  • Co-author or editor of 4 books related to examination technique, revision style and knowledge base
  • Author of chapters in core surgical texts in the UK (Bailey and Love) and USA (American College of Surgery textbook)
  • Internal and external (Imperial College) surgical examiner annually
  • Student Mentor (years 3-5) and Academic Scheme Mentor: Barts & the London SMD
  • Approved Educational Supervisor to ST programme at Homerton Hospital
  • Local lead for Academic Clinical Fellowships and prev. national surgical advisor to Walport scheme
  • Representative on the NE Thames London Deanery Specialist Training & Academic Steering Committees
  • National trainee surgical research network pilot steering group member
  • Senior advisor (and founder) or the London Surgical Research Group (trainee led)

Topics for PhD supervision:

  • A randomised mixed methods pilot (phase II exploratory trial) of sacral and percutaneous tibial nerve stimulation for faecal incontinence (N Thin)
  • Role of hypermobility and connective tissue disease in disorders of GI function (A Fikree)
  • Study of central afferent neural mechanisms of sacral nerve stimulation (E Carrington)
  • A translational study of voltage-gated sodium channels in visceral afferent signalling (G Boundouki)
  • Further development of human visceral afferent recordings (C McGuire)
  • CONtrol of Faecal Incontinence using Distal NeuromodulaTion (CONFIDeNT) study (E Horrocks)

Further information

Senior president of Barts and the London Student Running Club

Contact

Academic Surgical Unit
Centre for Digestive Diseases, Blizard Institute
Barts and The London School of Medicine and Dentistry
National Centre for Bowel Research and Surgical Innovation
1st Floor, Abernethy Building
2 Newark Street
London E1 2AT 

+44 20 7882 8757
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