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Dr Stephen John Middleton MA MD FRCP FAHE

Consultant Gastroenterologist
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Special Interests
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Irritable Bowel Syndrome (IBS) 
Dr Middleton has treated patients with IBS for over 20 years and is the lead clinician of the IBS service in Cambridge. He has a special interest in the dietary treatment of IBS which avoids the need for drug treatments in most cases.
Inflammatory bowel disease (IBD) Crohn’s disease and ulcerative colitis
Dr Middleton has over 20 years experience in treating patients with Crohn’s and ulcerative colitis. As well as gaining considerable experience in the use of existing treatments he has been involved in the development of new treatments for these conditions.  Dr Middleton has also undertaken and supervised laboratory based studies into these conditions to better understand their  scientific basis and is currently involved in clinical research as UK chief investigator for several large international  studies.
 
Endoscopy (Gastroscopy and Colonoscopy)
Dr Middleton is the lead gastroenterologist in Cambridge for selected endoscopic oesophageal procedures including the treatment of swallowing disorders such as Achalasia, diffuse oesophageal spasm and Nutcracker oesophagus.
 
He recently introduced the use of endoscopic Botox in Cambridge for these conditions. Before Botox there were few available treatments for these conditions and this now offers an excellent and low risk treatment. He also developed the service in Cambridge by introducing the practice of balloon dilatation to widen strictures (narrowing) of the oesophagus. These can be caused by acid reflux (heartburn) and sometimes by tumours. Since the introduction of balloon dilatation rather than bougies (rods) there have been far fewer complications of the procedure such as perforations (a split of the gullet). At the same time he introduced the use of a new type of stent to open the narrowing caused by tumours in the oesophagus, which is made of and expandable wire (alloy mesh which has memory for shape) and much less traumatic than the former more rigid plastic stents which tended to tear the oesophagus.
 
A recent audit of his therapeutic gastroscopy list  at Addenbrooke’s revealed that over the period of the audit (from 2000) there had been no perforations of benign strictures using these techniques, and a very low rate of complications with malignant strictures.

These  endoscopes vary from about 7mm to 11mm in diameter and can be steered through the stomach and bowel to allow examination and procedures such as a biopsy (taking a tiny piece of the lining for microscopic examination) removing polyps (small growths that can sometimes develop in to cancer) or dilating narrowed segments (strictures) which can cause a blockage.
Dyspepsia (indigestion) and Dysphagia (swallowing disorder)
The Cambridge Dyspepsia and Dysphagia (swallowing disorders) service was established by Dr Middleton in 1997 and was one of the first of its kind in the UK. He also set up a fast access route for patients with difficulty swallowing and a multidisciplinary team based approach which preceeded of the current national fast track service adopted in Cambridge some years later.
 
Dr Middleton has since set up a multidisciplinary team based approach for benign conditions of the stomach, intestine and oesophagus, many of which are caused by problems of coordinating movement along the lumen (passage) such as muscular spasm. This can cause severe pain in the chest and abdomen. Cambridge has a number of advanced and sophisticated diagnostic techniques which allow the movement (motility) disorders of the gastrointestinal tract to be identified to allow the correct treatment to be administered. Some of these tests are undertaken by the department of nuclear medicine and others in the GI physiology lab. The latter was founded by Dr Middleton in 1997 and he currently leads the service.
Constipation and Evacuatory Disorders
These common and very troubling conditions often require considerable expertise when they are present in their severe forms. They can be combined with IBS which makes their treatment even more difficult. Dr Middleton and his colorectal surgical colleague  have established a new service for these conditions and  they co-chair a multidisciplinary team in Cambridge. The service includes Biofeedback or Bowel retraining which is particularly effective for evacuatory disorders.
Nutrition and Transplantation
Dr Middleton has had a long standing interest in nutrition and intravenous feeding having formerly  led the  nutrition service in Cambridge. This has led him on to intestinal transplantation and a leading position in the national programme for adults. In 2013 Cambridge recorded 5 years survival figures for small bowel transplantation of 100% compared to the international registry figure of 57%. The technique offers an alternative to intravenous feeding for patients who have lost their intestines from disease or trauma.
 
Cambridge were the first in the UK and one of the first in the world to undertake this procedure and have had excellent results. Dr Middleton also founded the NASIT forum (National Adult Small Intesinal Transplantation forum) with a colleague from St Mark’s hospital London. This forum has been endorsed by the department of health as the official listing meeting for intestinal transplantation patients and provides a central point of contact for all those undertaking the procedure on adults in the UK where all potential patients can be discussed.