My Research Papers

Scientific Research Studies


Genetic Sequencing of Pediatric Patients Identifies Mutations in Monogenic Inflammatory Bowel Disease Genes that Translate to Distinct Clinical Phenotypes.

Ashton JJ, Mossotto E, Stafford IS, Haggarty R, Coelho TAF, Batra A, Afzal NA, Mort M, Bunyan D, Beattie RM, Ennis S.Clin Transl Gastroenterol. 2020 Feb;11(2):e00129. doi: 10.14309/ctg.0000000000000129.PMID: 32463623 

Challenges in chronic paediatric disease during the COVID-19 pandemic: diagnosis and management of inflammatory bowel disease in children.

Ashton JJ, Batra A, Coelho TAF, Afzal NA, Beattie RM.Arch Dis Child. 2020 Jul;105(7):706. doi: 10.1136/archdischild-2020-319482. Epub 2020 May 7.PMID: 32381515 

Long-term Outcomes of Paediatric Patients Admitted With Acute Severe Colitis- A Multicentre Study From the Paediatric IBD Porto Group of ESPGHAN.

Krauthammer A, Tzivinikos C, Assa A, Miele E, Strisciuglio C, Urlep D, Serban ED, Singh A, Winter HS, Russell RK, Hojsak I, Malham M, Navas-López VM, Croft NM, Lee HM, Ledder O, Shamasneh I, Hussey S, Huynh HQ, Wine E, Shah N, Sladek M, de Meij TG, Romano C, Dipasquale V, Lionetti P, Afzal NA, Aloi M, Lee K, Martín-de-Carpi J, Yerushalmy-Feler A, Subramanian S, Weiss B, Shouval DS.J Crohns Colitis. 2019 Dec 10;13(12):1518-1526. doi: 10.1093/ecco-jcc/jjz092.PMID: 31120524

Paediatric Endoscopy Global Rating Scale: Development of a Quality Improvement Tool and Results of a National Pilot.

Narula P, Broughton R, Howarth L, Piggott A, Bremner R, Tzivinikos C, Gillett P, Henderson P, Rawat D, Cullen M, Loganathan S, Devadason D, Afzal NA, Maginnis J, McKenna S, Thomson M, Green J, Johnston D.J Pediatr Gastroenterol Nutr. 2019 Aug;69(2):171-175. doi: 10.1097/MPG.0000000000002355.PMID: 30964821


Increased prevalence of anti-TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood.

Ashton JJ, Borca F, Mossotto E, Coelho T, Batra A, Afzal NA, Phan HTT, Stanton M, Ennis S, Beattie RM.Aliment Pharmacol Ther. 2019 Feb;49(4):398-407. doi: 10.1111/apt.15094. Epub 2019 Jan 9.PMID: 30628109

Use of Biosimilars in Pediatric Inflammatory Bowel Disease: An Updated Position Statement of the Pediatric IBD Porto Group of ESPGHAN.

de Ridder L, Assa A, Bronsky J, Romano C, Russell RK, Afzal NA, Hauer AC, Knafelz D, Lionetti P, Strisciuglio C, Veres G, Winter H, Wolters VM, Sladek M, Vulto AG, Dias JA; Paediatric IBD Porto group of ESPGHAN.J Pediatr Gastroenterol Nutr. 2019 Jan;68(1):144-153. doi: 10.1097/MPG.0000000000002141.PMID: 30169454

Endoscopy in Pediatric Inflammatory Bowel Disease: A Position Paper on Behalf of the Porto IBD Group of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition.

Oliva S, Thomson M, de Ridder L, Martín-de-Carpi J, Van Biervliet S, Braegger C, Dias JA, Kolacek S, Miele E, Buderus S, Bronsky J, Winter H, Navas-López VM, Assa A, Chong SKF, Afzal NA, Smets F, Shaoul R, Hussey S, Turner D, Cucchiara S.J Pediatr Gastroenterol Nutr. 2018 Sep;67(3):414-430. doi: 10.1097/MPG.0000000000002092.PMID: 30130311

Is the incidence of paediatric inflammatory bowel disease still increasing?

Ashton JJ, Cullen M, Afzal NA, Coelho T, Batra A, Beattie RM.Arch Dis Child. 2018 Nov;103(11):1093-1094. doi: 10.1136/archdischild-2018-315038. Epub 2018 Mar 8.PMID: 29519945 

Endoscopic and Histological Assessment of Paediatric Inflammatory Bowel Disease Over a 3-Year Follow-up Period.

Ashton JJ, Bonduelle Q, Mossotto E, Coelho T, Batra A, Afzal NA, Vadgama B, Ennis S, Beattie RM.J Pediatr Gastroenterol Nutr. 2018 Mar;66(3):402-409. doi: 10.1097/MPG.0000000000001729.PMID: 28922257

Challenges of modern day transition care in inflammatory bowel disease: From inflammatory bowel disease to biosimilars.

Hakizimana A, Ahmed I, Russell R, Wright M, Afzal NA.World J Gastroenterol. 2017 Jul 7;23(25):4473-4479. doi: 10.3748/wjg.v23.i25.4473.PMID: 28740335 

16S sequencing and functional analysis of the fecal microbiome during treatment of newly diagnosed pediatric inflammatory bowel disease.

Ashton JJ, Colquhoun CM, Cleary DW, Coelho T, Haggarty R, Mulder I, Batra A, Afzal NA, Beattie RM, Scott KP, Ennis S.Medicine (Baltimore). 2017 Jun;96(26):e7347. doi: 10.1097/MD.0000000000007347.PMID: 28658154

Exome Analysis of Rare and Common Variants within the NOD Signaling Pathway.

Andreoletti G, Shakhnovich V, Christenson K, Coelho T, Haggarty R, Afzal NA, Batra A, Petersen BS, Mort M, Beattie RM, Ennis S.Sci Rep. 2017 Apr 19;7:46454. doi: 10.1038/srep46454.PMID: 28422189 

Surgical Management of Crohn Disease in Children: Guidelines From the Paediatric IBD Porto Group of ESPGHAN.

Amil-Dias J, Kolacek S, Turner D, Pærregaard A, Rintala R, Afzal NA, Karolewska-Bochenek K, Bronsky J, Chong S, Fell J, Hojsak I, Hugot JP, Koletzko S, Kumar D, Lazowska-Przeorek I, Lillehei C, Lionetti P, Martin-de-Carpi J, Pakarinen M, Ruemmele FM, Shaoul R, Spray C, Staiano A, Sugarman I, Wilson DC, Winter H, Kolho KL; IBD Working Group of ESPGHAN (IBD Porto Group).J Pediatr Gastroenterol Nutr. 2017 May;64(5):818-835. doi: 10.1097/MPG.0000000000001562.PMID: 28267075

De novo and rare mutations in the HSPA1L heat shock gene associated with inflammatory bowel disease.

Takahashi S, Andreoletti G, Chen R, Munehira Y, Batra A, Afzal NA, Beattie RM, Bernstein JA, Ennis S, Snyder M.Genome Med. 2017 Jan 26;9(1):8. doi: 10.1186/s13073-016-0394-9.PMID: 28126021 

Genes implicated in thiopurine-induced toxicity: Comparing TPMT enzyme activity with clinical phenotype and exome data in a paediatric IBD cohort.

Coelho T, Andreoletti G, Ashton JJ, Batra A, Afzal NA, Gao Y, Williams AP, Beattie RM, Ennis S.Sci Rep. 2016 Oct 5;6:34658. doi: 10.1038/srep34658.PMID: 27703193

Identification of Variants in Genes Associated with Single-gene Inflammatory Bowel Disease by Whole-exome Sequencing.

Ashton JJ, Andreoletti G, Coelho T, Haggarty R, Batra A, Afzal NA, Beattie RM, Ennis S.Inflamm Bowel Dis. 2016 Oct;22(10):2317-27. doi: 10.1097/MIB.0000000000000890.PMID: 27537055

Nutritional perspectives of children with Crohn's disease: a single-centre cohort observation of disease activity, energy expenditure and dietary intake.

Wiskin AE, Haggarty R, Afzal NA, Batra A, Wootton SA, Beattie RM.Eur J Clin Nutr. 2016 Oct;70(10):1132-1137. doi: 10.1038/ejcn.2016.107. Epub 2016 Jun 22.PMID: 27329610 

Birimberg-Schwartz L, Wilson DC, Kolho KL, Karolewska-Bochenek K, Afzal NA, Spray C, Romano C, Lionetti P, Hauer AC, Martinez-Vinson C, Veres G, Escher JC, Turner D; paediatric IBD Porto group of ESPGHAN. pANCA and ASCA in Children with IBD-Unclassified, Crohn's Colitis, and Ulcerative Colitis-A Longitudinal Report from the IBD Porto Group of ESPGHAN. Inflamm Bowel Dis. 2016 Apr 29. [Epub ahead of print]


Ashton JJ, Versteegh HP, Batra A, Afzal NA, King A, Griffiths DM, Beattie RM, Stanton MP. Colectomy in pediatric ulcerative colitis: A single center experience of indications, outcomes, and complications. J Pediatr Surg. 2016 Feb;51(2):277-81


Ashton JJ, Coelho T, Ennis S, Batra A, Afzal NA, Beattie RM. Endoscopic versus histologic disease extent at presentation of paediatric inflammatory bowel disease (PIBD). Journal of Pediatric Gastroenterology and Nutrition. 2016 Feb;62(2):246-51


Tomlin J, Slater H, Muganthan T, Beattie RM, Afzal NA. Parental knowledge of Coeliac disease. Inform Health Soc Care. 2015 Sep;40(3):240-53.


Andreoletti G, Ashton JJ, Coelho T, Willis C, Haggarty R, Gibson J, Holloway J, Batra A, Afzal NA, Beattie RM, Ennis S. Exome analysis of patients with concurrent pediatric inflammatory bowel disease and autoimmune disease. Inflamm Bowel Dis. 2015 Jun;21(6):1229-36.


Ashton JJ, Coelho T, Ennis S, Batra A, Afzal NA, Beattie RM. Presenting phenotype of paediatric inflammatory bowel disease in Wessex, Southern England 2010-2013. Acta Paediatr. 2015 Aug;104(8):831-7.


Rahman I, Afzal NA, Patel P. The role of magnetic assisted capsule endoscopy (MACE) to aid visualisation in the upper GI tract. Comput Biol Med. 2015 Mar 24


Ashton JJ, Wiskin AE, Ennis S, Batra A, Afzal NA, Beattie RM. Rising incidence of paediatric inflammatory bowel disease (PIBD) in Wessex, Southern England. Arch Dis Child. 2014 Jul;99(7):659-64. 


Blackburn SC, Wiskin AE, Barnes C, Dick K, Afzal NA, Griffiths DM, Beattie RM, Stanton MP. Surgery for children with Crohn's disease: indications, complications and outcome. Arch Dis Child. 2014 May;99(5):420-6.


Venkataraman D, Howarth L, Beattie RM, Afzal NA. A very high Amylase can be benign in Crohn’s disease. BMJ Case Reports 2012 Jul 10;2012. pii: bcr0220125917. doi: 10.1136/bcr.02.2012.5917


Christodoulou K, Wiskin AE, Gibson J, Tapper W, Willis C, Afzal NA, Upstill-Goddard R, Holloway JW, Simpson MA, Beattie RM, Collins A, Ennis S. Next generation exome sequencing of paediatric inflammatory bowel disease patients identifies rare and novel variants in candidate genes. Gut. 2012 Apr 28 [online print]


Wiskin AE, Wootton SA, Cornelius VR, Afzal NA, Elia M, Beattie RM. No relationship between disease activity measured by clinical score, local and systemic inflammatory markers and resting energy expenditure in childhood Crohn’s disease. Journal of pediatric gastroenterology and nutrition. 2012 Feb;54(2):271-6.


Russell RK, Wilson ML, Loganathan S, Bourke B, Kiparissi F, Mahdi G, Torrente F, Rodrigues A, Davies I, Thomas A, Akobeng AK, Fagbemi A, Hyer W, Spray C, Vaish S, Rogers P, McGrogan P, Heuschkel RB, Aub N, Fell JM, Afzal NA, Green M, Murphy MS, Rao P, Shah N, Ho GT, Naik S, Wilson DC. A British society of paediatric gastroenterology, hepatology and nutrition survey of the effectiveness and safety of Adalimumab in children with inflammatory bowel disease. Alimentary Pharmacology and Therapeutics 2011 April; 33(8):946-53. Epub 2011 Feb 22


Wiskin AE, Wootton SA, Hunt TM, Cornelius VR, Afzal NA, Jackson AA, Beattie RM. Body composition in childhood inflammatory bowel disease. Clinical Nutrition 2011 Feb; 30(1):112-5 Epub 2010 Aug 21


Afzal NA, Shenoy MU, Haque S, Wilcox DT, Shah N. Recognition and treatment of genitourinary complications in paediatric Crohn’s disease using Infliximab. Acta Paediatrica 2010 July;99(7):1042-6. Epub 2010 Feb 23


Erlewyn-Lajeunesse M, Walker W, Basarab A, Eren E, Afzal N, Godfrey K, Faust SN. Linezolid an oral treatment for Staphylococcal liver abscess in chronic granulmoatous disease. Paediatric Infectious Disease Journal 2009 Nov; 28(11):1036-7


Wiskin AE, Wootton SA, Culliford DJ, Afzal NA, Jackson AA, Beattie RM. Impact of disease activity on resting energy expenditure in children with inflammatory bowel disease. Clin Nutr. 2009 Jun


Tighe MP, Morenas RA, Afzal NA, Beattie RM. Erythema ab igne and Crohn's disease. Archives Diseases in Childhood. 2008 May;93(5):389


Morenas RA, Tighe MP, Moore I, Afzal NA, Beattie RM. Latent coeliac disease in childhood? Gut. 2008 May;57(5):715-6


Howarth LJ, Wiskin AE, Griffiths DM, Afzal NA, Beattie RM. Outcome of childhood ulcerative colitis at 2 years. Acta Paediatr. 2007 Dec;96(12):1790-3


Thomson M, Antao B, Hall S, Afzal N, Hurlstone P, Swain CP, Fritscher-Ravens A. Medium-term outcome of endoluminal gastroplication with the EndoCinch device in children. J Pediatr Gastroenterol Nutr. 2008 Feb;46(2):172-7


Afzal NA, Ozzard A, Keady S, Thomson M, Murch S, Heuschkel R. Infliximab delays, but does not avoid, the need for surgery in treatment-resistant paediatric Crohn’s disease. Digestive diseases and sciences 2005. Dig Dis Sci. 2007 Dec;52(12):3329-33


Afzal NA, Davies S, Paintin M, Arnaud-Battandier F, Walker-Smith JA, Murch SH, Heuschkel R, Fell JM. Colonic Crohn’s disease in children does not respond well to treatment with enteral nutrition if the ileum is not involved. Digestive diseases and sciences 2005; Aug;50(8):1471-5


Thomson M, Sharon H, Afzal N, Ashwood P, Fritscher-Ravens A, Swain P. Endoluminal gastroplication in children with gastro-oesophageal reflux disease: 1 year follow-up. Gut. Dec 2004;53(12):1745-50


Castellaneta SP, Afzal NA, Greenberg M, Francavilla R, Deere H, Davies S, Murch SH, Walker-Smith JA, Thomson M. Diagnostic role of upper gastrointestinal endoscopy in paediatric inflammatory bowel disease. Journal of pediatric gastroenterology and nutrition. Sep 2004;39(3):257-61


Afzal NA, Loonen H, Arnaud- Battandier F, Davies S, Murch S, Derkx B, Heuschkel R, Fell J. Improvement in quality of life in children with acute Crohn’s disease does not parallel mucosal healing after treatment with exclusive enteral nutrition. Alimentary Pharmacology and Therapeutics 2004 Jul 15;20(2):167-72


Afzal NA, Murch SH, Thirrupathy K, Berger L, Fagbemi A, Heuschkel RB. Constipation with acquired megarectum in children with autism. Pediatrics 2003 Oct;112(4):939-42


Dick A, Keady S, Mohamed F, Brayley S, Thomson M, Lloyd BW, Heuschkel R, Afzal NA. Use of unlicensed and off-label medications in paediatric gastroenterology with a review of the commonly used formularies in UK. Alimentary Pharmacology and Therapeutics 2003 Feb;17(4):571-5.


Afzal NA, Albert D, Lloyd-Thomas A, Thomson M. A child with oesophageal strictures. Lancet 2002 Mar 23;359(9311):1032


Afzal NA, Addai SA, Fagbemi A, Murch SH, Thomson MA, Heuschkel RB. Refeeding syndrome with enteral nutrition in children: a case report, literature review and clinical guidelines. Clinical Nutrition 2002 Dec;21(6):515-20.


Heuschkel R, Afzal N, Wuerth A, Tolia V, Kemper K, Bousvaros A. The use of alternative medicines in children and young adults with inflammatory bowel disease. American Journal of Gastroenterology 2002 Feb;97(2):382-8


Afzal NA, Brueton M, Fell JM, Baker A. Portal vein thrombosis and pancreatic failure. International Journal of Pancreatology 2001; 29 (2), 109-113


Afzal NA, Martin DI, Atkinson PI. Missing milestones. Early Child Development and Care 2001;167: 51-62



Expert Reviews


Rahman I, Patel P, Boger P, Rasheed S, Thomson M, Afzal NA. Therapeutic upper gastrointestinal tract endoscopy in Paediatric Gastroenterology. World J Gastrointest Endosc. 2015 Mar 16;7(3):169-82. doi: 10.4253/wjge.v7.i3.169. Review.


Tighe M, Afzal NA, Bevan A, Hayen A, Munro A, Beattie RM. Pharmacological treatment of children with gastro-oesophageal reflux. Cochrane Database Syst Rev. 2014 Nov 24;11:CD008550. 


Tighe MP, JR Fraser Cummings, Afzal NA. Nutrition and inflammatory bowel disease: primary or adjuvant therapy. Current Opinion in Clinical Nutrition and Metabolic Care 2011 Sep; 14(5): 491-6


Afzal NA, Tighe MP, Thomson MA. Constipation in children. Italian Journal of Pediatrics 2011, June 13;37:28


Tighe MP, Afzal NA, Bevan A, Beattie RM. Current pharmacological management of gastro-esophageal reflux in children: an evidence-based systematic review. Paediatric Drugs. 2009;11(3):185-202


Afzal NA, Thomson M. Constipation in Children. Independent Nurse. Healthcare Republic News. September 2008.

Also available online


Afzal NA, Thomson M. Constipation in Children. GP. Healthcare Republic News. October 2007

Also available online


Beattie RM, Croft NM, Fell JM, Afzal NA, Heuschkel RB. Inflammatory bowel disease. Archives of diseases in childhood.


Afzal NA, Thomson M. Diarrhoea and gastroenteritis in the infant and young child. The journal of family health care 2002; 12 (6):146-150


Afzal NA, Thomson M. Management of constipation in children. Prescriber. May 19, 2001; 101-107



Book Chapters


Afzal NA, Thomson M. Interventional Endoscopy: recent innovations. Pediatric Gastrointestinal Disease. Pathophysiology, diagnosis, management. 6th edition (in press).


Afzal NA, Thomson M. Interventional Endoscopy: recent innovations. Pediatric Gastrointestinal Disease. Pathophysiology, diagnosis, management. 5th edition.


Afzal NA, Heuschkel RB. Alternative Medical Treatment. Pediatric Gastrointestinal Disease. Pathophysiology, diagnosis, management. 4th edition.


Afzal NA, Thomson M. Diverticular disease in adolescence. Balliere’s best practice & research: Clinical gastroenterology; 16 (4): 621-34





Rahman I, Patel P, Boger P, Thomson M, Afzal NA. Utilisation of magnets to enhance gastrointestinal endoscopy. World Journal of Gastrointestinal Endoscopy 2015 Dec 25;7(19):1306-1





Ahmed F, Afzal NA. Editors. Medical Disaster Response Manual, 3rd edition (167 pages). Published by Humanity First International and Humanity First Medical.

This manual forms the basis for the Humanity First disaster response course which has been running for the last three years in the UK and more recently in the US. The last course in 2012 was supported by Department for International Development, UK (DFID) and facilitated by Humanity First; the manual approved for use in the course by DFID.


Afzal F, Afzal NA and Bullard C. Editors & Authors. Atoms for Peace. This ebook is an informative scientific work, intended for young scientists and lay readers, in which an in-depth analysis of the power and the effects of nuclear power is given. It is a book primarily addressed at the young, questioning mind; at people who are finding out about the great questions of our modern world.



Online Training modules for doctors


Tighe M, Martin J, Afzal NA. Guideline debrief: GORD in children. 2 hours CPD. Pulse Learning. (34 Reviews - Readership Rating of 4 out of 5 stars)


Saha A, Afzal NA. Key questions on gastroenteritis in children. 1.5 hours CPD. Pulse Learning. (62 reviews – Readership Rating of 4.5 out of 5 stars)