Aala Mohammed Ali

Medical Student Prize Winner

“Characterising chronotype, sleep, and circadian disruption in inflammatory bowel disease (IBD).”

The human body works on a 24-hour daily cycle and is run by an internal body system known as the circadian clock which uses environmental cues e.g. food and sunlight, to adjust daily activities. Circadian preferences are characterised into three types; ‘morning larks’ who are more alert and show greater preference for working during the early hours, ‘night owls’ who show the opposite preference, and ‘intermediate type’ who display a flexible preference for working.

Research has shown that a ‘later’ chronotype is associated with greater risks of experiencing severe IBD, possibly caused by disturbances to the circadian process by factors like shift work. Additionally, there is a strong association identified between the immune pathways involved in inflammation and the circadian clock through genetic and rhythmic patterns, which could point to a possible relationship with IBD.

The aim of this study is to build on these findings and try to understand in more detail the exact role the circadian mechanism and chronotypes play in the development and presentation of symptoms in patients suffering from IBD.

An initial pilot study carried out across two hospital trusts within the Greater Manchester area between March-July 2021 found a greater prevalence of ‘morning’ chronotype amongst the cohort of participants with Ulcerative colitis compared to Crohn’s Disease, with sleep and eating patterns having the most significant influence on severity and presentation of symptoms in participants with both forms of IBD.

Through exploring this potential relationship between the circadian clock and disease mechanisms of IBD, many areas of disease management can be further understood and improved. For example, applying the method of chronotherapy, which involves matching timing of medication to a person’s chronotype preferences, to obtain greater benefits from drug therapies in IBD. Also, a greater understanding on new fields which influence the severity and presentation of IBD can be helpful in developing new management and care pathways, which can be used in both primary and secondary care, to identify at risk individuals and prevent the worsening of IBD and its debilitating chronic symptoms, may be achieved through the findings of this project. Finally, by taking a holistic approach, we hope that this knowledge will aid in the personalisation – and improvement – of individual IBD management. Ultimately, the team hope this may lead to influencing on future management of IBD and patient care across the NHS.

Why did you choose this project?

“I have been interested in chronic conditions – including IBD – and the impact that they have on individual’s quality of life since the beginning of clinical medicine. Working with patients to consider and develop new and integrative approaches to improve their experience and journey is something that I feel is a very important part in the management of chronic conditions such as IBD.”