Hepatology

Welcome to the Hepatology department of Royal Surrey NHS Foundation Trust. The team comprises four consultant hepatologists looking after patients with liver disease. Our consultants are supported by five hepatology/viral hepatitis specialist nurses, an award-winning alcohol liaison team, and an outreach Hepatitis C team who are the winners of the Nursing Times Community Nursing award, and the South East regional winner in the Health Equalities Award Category of the NHS Parliamentary Awards.

We run clinics for viral hepatitis, autoimmune liver disease, liver cirrhosis, vascular liver disease and alcohol-related liver disease and manage all aspects of metabolic liver disease including non-alcohol fatty liver disease (NAFLD), hereditary haemochromatosis and Wilson's disease.

The team provide day care services for paracentesis and a nurse lead venesection service treating over 100 haemochromatosis patients. Fibro-scanning is also provided as an integral part of the liver service.

Our consultants have all trained in liver transplant centres and look after patients who have received liver transplants or who have transplant-related complications. Our consultants are also core members of the hepatopancreatobiliary (HPB) multidisciplinary team and have extensive experience in the management cancer originating in the liver, the biliary tree, the pancreas and the gallbladder. They are also responsible for providing therapeutic endoscopy service in and out of hours.

We pride ourselves in being the only district general hospital in the country commissioned to deliver therapy for patients with hepatitis C (Operational Delivery Network -ODN). We are also the regional centre providing therapy for the rare liver disorder primary biliary cholangitis (PBC). Moreover, we are a recognised global centre of excellence for the management Wilson disease as recognised by the Wilson Disease association (WDA). 

Meet the team

The team is comprised of four consultant hepatologists looking after patients with liver disease. Our consultants are supported by five hepatology / viral hepatitis specialist nurses, an award-winning alcohol liaison team and an outreach Hepatitis C team who are the winners of the Nursing Times Community Nursing award and are the South East regional winner in the Health Equalities Award Category of the NHS Parliamentary Awards.

Consultants

Prof. Aftab Ala

Dr Michelle Gallagher

Dr Sanju Mathew

Dr Marinos Pericleous

Dr Dushen Murguiah

 

Secretaries
Clare Rose
Secretary to: Prof Aftab Ala and Dr Marinos Pericleous
01483 571122 Ext. 6990

Helen Wilson
Secretary to: Dr Michelle Gallagher
01483 571122 Ext. 6519

Nicola Keen
Secretary to: Dr Sanju Mathew, and Dr Dushen Murguiah
01483 571122  Ext. 4933 / 5239

 

We have extensive experience in clinical and translational research and, over the years, have built strong regional, national and international collaborations. The Royal Surrey is the regional South East England hub for the local clinical research network (LCRN) for National Institute for Health and Research (NIHR). We have expertise in translational research related to chronic viral hepatitis, rare genetic liver diseases such as Wilson diseases and PBC, liver cancer and more recently COVID-19.  In 2018, we received an NIHR National Award of recognition for the greatest increase in clinical trial studies in any UK Hepatology clinical research network.

 

Patient Information

You might find the following websites useful for information and advice. Please note that Royal Surrey NHS Foundation Trust is not responsible for the content or updating of these sites.

Alcohol Change UK
A charity promoting alcohol change, working towards improved knowledge, better policies and regulation, shifted cultural norms, improved drinking behaviours, and more and better support and treatment.

British Liver Trust
The UK's leading liver health charity.

Love Your Liver
A British Liver Trust national awareness campaign devoted to liver health awareness and giving people the key steps needed to keep their liver healthy.

NHS: BMI healthy weight calculator
Use the calculator on the NHS website to check your body mass index and find out if you are a healthy weight.

The Wellness Toolbox - Cirrhosis
Providing nutrition and exercise resources to help you stay healthy when living with cirrhosis.

 

Haemochromatosis

Haemochromatosis UK
Helping people live with iron overload.

 

Hepatitis

UK-AIH
UK-AIH is a research collaboration with a shared interest in understanding and treating the autoimmune liver disease autoimmune hepatitis.

The Hepatitis B Positive Trust UK
Aiming to end the silence around hepatitis B infections and draw together people with hepatitis B to give them a collective voice and the ability to support each other.

The Hepatitis C Trust
Raising public awareness of the virus, ending discrimination about people with hepatitis C, and creating an active community of patients.

 

Non-alcoholic fatty liver disease

NHS: Non-alcoholic fatty liver disease
Find information about non-alcoholic fatty liver disease on the NHS website.

 

Pancreatic cancer

Pancreatic Cancer UK
Providing expert support and information, funding research and campaigning for change.

 

Primary Biliary Cholangitis (PBC)

PBC Foundation
A charity offering support to PBC sufferers, their family and friends.

PSC Support
Helping anyone affected by PSC and driving research towards a cure.

 

Wilson's disease

Wilson's Disease Support Group UK
Support, education and outreach for people living with Wilson's disease, their family and friends.

Information for Health Professionals

British Association for the Study of the Liver
Dedicated to advancing knowledge and understanding of the biology and pathology of the liver for the optimal care of patients.

Improving Quality in Liver Services
A Royal College of Physicians programme, aiming to improve the quality of medical liver services throughout the UK.

 

Selected peer-reviewed publications

  1. Kelly C, Pericleous M, Ahmed A, Vandrevala T, Hendy J, Shafi S, Skene S, Verma S, Edge C, Nicholls M, Gore C, de Lusignan S, Ala A. . Improving uptake of hepatitis B and hepatitis C testing in South Asian migrants in community and faith settings using educational interventions - a prospective descriptive study. International Journal of Infectious Diseases 2020:S1201-9712(20)30689-5. doi: 10.1016/j.ijid.2020.08.059. Epub ahead of print. PMID: 32861830.
  2. Pericleous M, Kelly C, Odin JA, Kallis Y, McGee C, Sherlock J, Yonova I, de Lusignan S, Ala A. Clinical Ontologies Improve Case Finding of Primary Biliary Cholangitis in UK Primary and Secondary Care. Dig Dis Sci. 2020 Jan 17. doi: 10.1007/s10620-019-06039-x. Epub ahead of print. PMID: 31953628.
  3. Avellon, A., Ala, A., Diaz, A., Domingo, D., Gonzalez, R., Hidalgo, L., Kooner, P., Loganathan, S., Martin, D., McPherson, S., Munoz-Chimeno, M., Ryder, S., Slapak, G., Ryan, P., Valbuena, M., & Kennedy, P. T. (2020). Clinical performance of Determine HBsAg 2 rapid test for Hepatitis B detection. Journal of medical virology, 10.1002/jmv.25862. Advance online publication. https://doi.org/10.1002/jmv.25862
  4. Camarata MA, Gottfried M, Rule JA, Ala A, Lee WM, Todd Stravitz R, Schilsky ML. Outcomes of Acute Liver Injury in Adults Due to Wilson's Disease: Is Survival Without Transplant Possible? Liver Transpl. 2020 Mar;26(3):330-336. doi: 10.1002/lt.25703. PMID: 31838773.
  5. Edge C, George J, Black G, Gallagher M, Ala A, Patel S, Edwards S, Hayward A. Using telemedicine to improve access, cost and quality of secondary care for people in prison in England: a hybrid type 2 implementation effectiveness study. BMJ Open. 2020 Feb 18;10(2):e035837. doi: 10.1136/bmjopen-2019-035837. PMID: 32075846; PMCID: PMC7044812
  6. Solovyev N, Ala A, Schilsky M, Mills C, Willis K, Harrington CF. Biomedical copper speciation in relation to Wilson's disease using strong anion exchange chromatography coupled to triple quadrupole inductively coupled plasma mass spectrometry. Anal Chim Acta. 2020;1098:27-36. doi:10.1016/j.aca.2019.11.033
  7. Camarata MA, Ala A, Schilsky ML. Zinc Maintenance Therapy for Wilson Disease: A Comparison Between Zinc Acetate and Alternative Zinc Preparations. Hepatol Commun. 2019 Jul 23;3(8):1151-1158. doi: 10.1002/hep4.1384. PMID: 31388634; PMCID: PMC6671772
  8. Ahmed A, Vandrevala T, Hendy J, Kelly C, Ala A. An examination of how to engage migrants in the research process: building trust through an 'insider' perspective. Ethn Health. 2019 Nov 13:1-20.
  9. Hendy J, Vandrevala T, Ahmed A, Kelly C, Gray L, Ala A. Feeling misidentified: Understanding migrant's readiness to engage in health care screening. Soc Sci Med. 2019 Sep;237:112481.
  10. Wijetilleka S, Mukhtyar C, Jayne D, Ala A, Bright P, Chinoy H, Harper L, Kazmi M, Kiani-Alikhan S, Li C, Misbah S, Oni L, Price-Kuehne F, Salama A, Workman S,Wrench D, Karim MY. Immunoglobulin replacement for secondary immunodeficiency after B-cell targeted therapies in autoimmune rheumatic disease: Systematic literature review. Autoimmun Rev. 2019. S1568-9972(19)30063
  11. Harrod E, Moctezuma-Velazquez C, Gurakar A , Ala A, Dieterich D, Saberi A Management of concomitant hepatocellular carcinoma and chronic hepatitis C: a review. Hepatoma Res 2019;5:28.
  12. Wijetilleka S, Jayne DR, Mukhtyar C, Ala A, Bright PD, Chinoy H, Harper L,Kazmi MA, Kiani-Alikhan S, Li CK, Misbah SA, Oni L, Price-Kuehne FE, Salama AD,Workman S, Wrench D, Karim MY. Recommendations for the management of secondary hypogammaglobulinaemia due to B cell targeted therapies in autoimmune rheumatic diseases. Rheumatology (Oxford). 2018
  13. Dyson JK, Wong LL, Bigirumurame T, Hirschfield GM, Kendrick S, Oo YH, Lohse AW, Heneghan MA, Jones DEJ; UK-AIH Consortium. Inequity of care provision and outcome disparity in autoimmune hepatitis in the United Kingdom. Aliment Pharmacol Ther. 2018;48(9):951-960.
  14. Carbone M, Nardi A, Flack S, Carpino G, Varvaropoulou N, Gavrila C, Spicer A, Badrock J, Bernuzzi F, Cardinale V, Ainsworth HF, Heneghan MA, Thorburn D,Bathgate A, Jones R, Neuberger JM, Battezzati PM, Zuin M, Taylor-Robinson S, Donato MF, Kirby J, Mitchell-Thain R, Floreani A, Sampaziotis F, Muratori L,Alvaro D, Marzioni M, Miele L, Marra F, Giannini E, Gaudio E, Ronca V, Bonato G, Cristoferi L, Malinverno F, Gerussi A, Stocken DD, Cordell HJ, Hirschfield GM, Alexander GJ, Sandford RN, Jones DE, Invernizzi P, Mells GF; Italian PBC Study Group and the UK–PBC Consortium. Pretreatment prediction of response to ursodeoxycholic acid in primary biliary cholangitis: development and validation of the UDCA Response Score. Lancet Gastroenterol Hepatol. 2018 Sep;3(9):626-634.
  15. Pericleous M, Kelly C, Ala A, De Lusignan S. The role of the chronic caremodel in promoting the management of the patient with rare liver disease. Expert Rev Gastroenterol Hepatol. 2018;12(8):829-841. 16. Camarata M, Ala A, Schilsky ML; Update on Wilson Disease: focus on WTX-101; Drugs of the Future 2018, 43(7): 501-507
  16. Kelly C, Pericleous M, Hendy J, de Lusignan S, Ahmed A, Vandrevala T, Ala A.Interventions to improve the uptake of screening across a range of conditions in Ethnic Minority Groups: a systematic review. Int J Clin Pract. 2018 Jun 19:e13202.
  17. Weiss KH, Askari FK, Czlonkowska A, Ferenci P, Bronstein JM, Bega D, Ala A, Nicholl D, Flint S, Olsson L, Plitz T, Bjartmar C, Schilsky ML. Bis-choline tetrathiomolybdate in patients with Wilson's disease: an open-label, multicentre, phase 2 study. Lancet Gastroenterol Hepatol. 2017;2(12):869-876.
  18. Pericleous M, Kelly C, Wang T, Livingstone C, Ala A. Wolman's disease and cholesteryl ester storage disorder: the phenotypic spectrum of lysosomal acid lipase deficiency. Lancet Gastroenterol Hepatol. 2017;2(9):670-679
  19. Ala A. Wilson’s Disease. Medicine International; 2016; 43(11), 661-663 21. Basaranoglu M, Ertan M, Mathew S, Kaplan M, Ala A, Demibarg A. Rate and Predictors of Endoscopic Mucosal Healing in Biologic Naive Patients with Inflammatory Bowel Disease by Azathioprine Treatment: A Real World, 10 Years Experience from a Single Centre in Turkey. Journal of Gastrointestinal and Digestive System 2016; 6(4),1-5
  20. AV Hadjinicolaou, C Hadjittofi, PG Athanasopoulos, R Shah, A Ala. Primary small bowel melanomas: fact or myth?Annals of translational medicine. 2016; 4 (6).113 23. Ratziu V, Harrison SA, Francque S, Bedossa P, Lehert P, Serfaty L,Romero-Gomez M, Boursier J, Abdelmalek M, Caldwell S, Drenth J, Anstee QM, Hum D,Hanf R, Roudot A, Megnien S, Staels B, Sanyal A;GOLDEN-505 Investigator Study Group. Elafibranor, an Agonist of the Peroxisome Proliferator-Activated Receptor-α and -δ, Induces Resolution of Nonalcoholic Steatohepatitis Without Fibrosis Worsening. Gastroenterology. 2016;150(5):1147-1159
  21. Carbone M, Sharp SJ, Flack S, Paximadas D, Spiess K, Adgey C, Griffiths L, Lim R, Trembling P, Williamson K, Wareham NJ, Aldersley M, Bathgate A, Burroughs AK, Heneghan MA, Neuberger JM, Thorburn D, Hirschfield GM, Cordell HJ, Alexander GJ, Jones DE, Sandford RN, Mells GF; members of the UK-PBC Consortium. The UK-PBC risk scores: Derivation and validation of a scoring system for long-term prediction of end-stage liver disease in primary biliary cholangitis. Hepatology.2016;63(3):930-50
  22. Cordell HJ, Han Y, Mells GF, Li Y, Hirschfield GM, Greene CS, Xie G, Juran BD,Zhu D, Qian DC, Floyd JA, Morley KI, Prati D, Lleo A, Cusi D; Canadian-US PBC Consortium; Italian PBC Genetics Study Group; UK-PBC Consortium, Gershwin ME,Anderson CA, Lazaridis KN, Invernizzi P, Seldin MF, Sandford RN, Amos CI,Siminovitch KA. International genome-wide meta-analysis identifies new primary biliary cirrhosis risk loci and targetable pathogenic pathways. Nat Commun. 2015 ;6:8019.
  23. Thursz MR, Richardson P, Allison M, Austin A, Bowers M, Day CP, Downs N,Gleeson D, MacGilchrist A, Grant A, Hood S, Masson S, McCune A, Mellor J, O'Grady J, Patch D, Ratcliffe I, Roderick P, Stanton L, Vergis N, Wright M, Ryder S,Forrest EH; STOPAH Trial cosortia Prednisolone or pentoxifylline for alcoholic hepatitis. N Engl J Med. 2015;372(17):1619-28.
  24. Basaranoglu M, Sayilir A, Demirbag E, Mathew S, Ala A, Senturk S. Seasonal clustering in Inflammatory Bowel Disease (IBD):A single centre experience. Expert Rev Gastroenterol Hepatol. 2015 9(6):877-81
  25. Berry P, Langlands S, Campbell C, Driekze N, Ala A, Karat I, Keeling P. Removing PEG tubes with ‘buried bumpers’:lessons learnt from four patients. Clini Nutrition 2015;10(2), e49-e51
  26. Ala A, Aliu E, Schilsky M, Prospective pilot study of a single daily dosage of Trientine for the treatment of Wilson Disease. Digestive Diseases and Sciences. Dig Dis Sci. 2015; 60(5):1433-9
  27. Ala A. Wilson’s Disease. Medicine International. 2015; l43 (11) 2015; 661-663

Grants to the department

Grants to the department (2015 - current)

2020 Developing and Delivering targeted SARS-CoV-2(COVID-19) health interventions to Black, Asian and Minority Ethnic (BAME) communities living in the UK- The Cobham Study (AA Chief Investigator £371,734)

 

2019 Wilson Disease Association to develop and deliver UK-USA Wilson Disease Registry Programme (AA Chief Investigator $278,690, 4 years)

 

2018 NIHR Doctoral fellowship “Using telemedicine to improve access and quality of secondary care for people in prison, and cost effectiveness of health care provision” AA Clinical Supervisor (£426,800) 4 years

 

2018 Wilsons Disease Association to support USA- Europe Wilson disease Natural History Registry programme.  AA Chief Investigator $251,000  3 year

 

2018 Wilson Disease Association (WDA USA) to support Clinical Research fellow programme to work at Royal Surrey County Hospital (AA $50,000) 1 year

 

2017 Wilson Disease Association (WDA USA) to support Clinical Research fellow programme to work at Yale University – “Developing the Wilson registry programme” (AA $78,000) 1 year

 

2017 Academic Programme Activity Award Royal Surrey County Hospital to support clinical trials programme (£11,500) 1 year

 

2016 Europe and Canada Practise to Policy Health Awards programme: 25,000 Euros- Characterising linkage in the PBC patient from primary to secondary care in South England. AA/MP (25,000 Euros)

 

2015 National Institute for Health and Research (NIHR) RfPB PB-PG-1013-32094 – An Innovative Educational Intervention to Improve Uptake of Hepatitis B And C Testing In South East Asians: Intervention Development and A Feasibility Study for a Randomised Control Trial. Chief Investigator: AA. (£329,421) 2.5 years

 

2015 Improving the detection and uptake of LAL(lysosomal acid lipase) deficiency and uptake in South East England at risk individuals. Alexion Pharmaceuticals. Chief Investigator: AA (£47,000). 1 year

 

2015 Real world PBC (Primary Biliary Cirrhosis) patient pathways in South East England. Chief Investigator  Aftab  Ala . Intercept Pharmaceuticals. (AA £43,000). 1 year

 

2015 NIHR Clinical Research Network(CRN) Kent, Surrey and Sussex Clinical Research Strategic Funding for Hepatology Trial Management. Chief Investigator: AA (£6,000) 1 year

 

Selected clinical trials

Selected Clinical Trials
Short Title Full Title
A Phase 3 Double Blind, Randomized Placebo Study of MGL‐3196 A Phase 3, Multinational, Double-Blind, Randomized, Placebo-Controlled Study of MGL-3196 (resmetirom) in Patients With Non-Alcoholic Steatohepatitis (NASH) and Fibrosis to Resolve NASH and Reduce Progression to Cirrhosis and/or Hepatic Decompensation
A study to evaluate JNJ-64300535 DNA vaccine in chronic Hepatitis B A first-in-human, double-blind, randomized, placebo-controlled, Phase 1 study to evaluate the safety, tolerability, reactogenicity, and immunogenicity of JNJ-64300535, a DNA vaccine, administered by electroporation-mediated intramuscular injection, in participants with chronic hepatitis B who are on stable nucleos(t)ide therapy and virologically suppressed.
Albumin To prevenT Infection in chronic liveR failurE (ATTIRE) Albumin To prevenT Infection in chronic liveR failurE (ATTIRE)
AURORA A Phase 3, Multicenter, Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of Cenicriviroc in Adult Subjects with Nonalcoholic Steatohepatitis and Liver Fibrosis
Beta-blockers or placebo for primary prophylaxis (BOPPP) Trial Beta Blockers or placebo for primary prophylaxis of oesophageal varices (BOPPP Trial). A blinded, multi-centre, clinical effectiveness and cost-effectiveness randomised controlled trial
CHELATE STUDY GMPO-131-002 CHELATE STUDY: Trientine tetrahydrochloride (TETA 4HCl) for the treatment of Wilson’s disease
COBHAM study Developing and Delivering targeted SARS-CoV-2(COVID-19) health interventions to Black, Asian and Minority Ethnic (BAME) communities living in the UK
HEPA - 5032 The REGENERATE Study A Phase 3, Double-Blind, Randomized, Long-Term, Placebo-Controlled, Multicenter Study Evaluating the Safety and Efficacy of Obeticholic Acid in Subjects with Nonalcoholic Steatohepatitis
HEPA 4066 (Wilson Disease) A Phase 2, Multi-centre, Open-label, Study to Evaluate the Efficacy and Safety of WTX101 Administered for 24 Weeks in Newly Diagnosed Wilson Disease Patients Aged 18 and Older with an Extension Phase of 12 Months
Methotrexate induced liver fibrosis Evaluation of the role of AST:ALT ratio, ELF markers and fibroscan in the detection of methotrexate induced hepatotoxicity
NAFLD BioResource The NAFLD BioResource, part of the NIHR BioResource – A Research Study to Characterise Novel Clinical and Genetic Phenotypes, and Understand the Natural History of Non-Alcoholic Fatty Liver Disease (NAFLD)
NASH Genotype Case-control Study Evaluating the Genetic Factors Associated with the Development of Non-Alcoholic Steatohepatitis
Natural history and pathogenesis of systemic IgG4 disease Natural history and pathogenesis of systemic IgG4 disease
Norursodeoxycholic acid vs. Placebo in PSC Double-blind, randomized, placebo-controlled, phase III study comparing norursodeoxycholic acid capsules with placebo in the treatment of primary sclerosing cholangitis

 

Collaborations

Michael Schilsky - Yale University, USA Wilsons disease

Prof Karl Heinz Weiss, Heidelberg University, Germany - Liver cancer and Wilsons disease

Professor Seema Alam, ILBS, New Delhi, India Wilsons disease

Professor Peter Ott, Copenhagen, Denmark   Wilsons disease

Sir Professor Alimuddin Zumla - UCL, London, COVID-19

Professor Anil Dhawan, Kings College Hospital, London

Professor Andrew Hayward- UCL, COVID-19

Professor Jane Hendy- Brunel University, London

Dr Usman Darr, Chatham House, London

Dr Chris Harrington, Trace Elements Laboratory, Royal Surrey