Improving the lives of people with intestinal failure

Patients being treated for intestinal failure at the Bristol Royal Infirmary could benefit from a simple test used to measure how salty their urine is. Clinicians at University Hospitals Bristol have come up with the idea of using a test that is routinely used to measure the amount of chlorine in swimming pools. This could identify patients who are becoming dehydrated promptly and allow earlier treatment.

Dr Jonathan Tyrrell-Price, consultant gastroenterologist and nutrition lead at Bristol Royal Infirmary, realised that a dip stick, known as the Quantab chloride stick – commonly used in industry to test chloride in solution – might work in a clinical setting to measure chloride in patient’s urine. Dr Tyrrell-Price worked with a clinical colleague, Dr Fergus Hamilton and Professor Andy Ness, director of the National Institute for Health Research Biomedical Research Unit in Nutrition, Diet and Lifestyle at University Hospitals Bristol NHS Foundation Trust and the University of Bristol to develop a research proposal to explore the value of these sticks.

Professor Andy Ness said: “This is a promising idea that has the potential to improve the lives of people with intestinal failure. I look forward to working with Dr Tyrrell-Price and Dr Hamilton to design and carry out the studies to show whether this simple test can fulfil its promise.”

The Quantab sticks are currently being tested on patient’s urine, with intestinal failure, in the laboratories at Bristol Royal Infirmary. Jonathan Tyrrell-Price said: “People with short bowel cannot always absorb oral fluids properly and consequently managing their hydration is difficult. On the ward we use urinary sodium to detect dehydration. I thought there must be a way to measure salts in a solution which could be used in someone’s home. The Quantab stick was identified after discussion with the University Chemistry department. I hope this will give greater autonomy and better care for this vulnerable population and have wider applications to other vulnerable groups.”

The research team have recently won a grant for £10,000 from the NHS Innovation Prize Challenge having won the Acorn Challenge. Dr Hamilton said: “This money will ensure we can extend the use of this stick to diagnose dehydration in other patient populations – such as nursing home patients. This could allow diagnosis and care to start in the community, expediting diagnosis and treatment of sick patients, while allowing safe management in the community, potentially avoiding hospital admissions.

Sir Bruce Keogh, NHS England’s Medical Director who presented the awards, said: “Britain has a proud history of discovery and innovation from the smallpox vaccine, to antibiotics, to the discovery and sequencing of DNA; from the clinical thermometer, to the ECG to MRI scanners.

“This year the innovation prizes showcase local innovations to improve care through the use of technology, infection control and rehabilitation, along with new ways of helping people with diabetes. Recognition and reward of local innovations not only promotes further innovation it is an important step in ensuring improvement across our NHS.”