The MAHSC (Manchester Academic Health Science Centre) inaugural lecture series celebrates the remarkable contributions of our honorary MAHSC clinical chairs. These prestigious honors, awarded by the University of Manchester’s Faculty of Biology, Medicine, and Health, recognise distinguished individuals across Greater Manchester who have demonstrated excellence in research, education, and clinical practice.

Professor Peter Paine, Consultant Gastroenterologist at Northern Care Alliance NHS Foundation Trust delivered his MAHSC Inaugural Lecture with a rich reflection on his career journey in Neurogastroenterology, describing how he became what he colloquially calls an “enteric electrician.”

Setting Out: A Wandering Path

Professor Paine first acknowledged his long-time colleague, Prof John McLaughlin, for his enduring support.

He described how neurogastroenterology – the study of disorders of gut-brain interaction – became his subspecialty, even though it remains one of the least popular fields in UK gastroenterology, with only around 20–30 consultants formally specialising.

His interest began during an intercalated BSc in sociology applied to medicine at St George’s Hospital Medical School, where he was introduced to the biopsychosocial model of disease. Early clinical encounters, including a particularly formative case involving a distressed young IBS patient, demonstrated the need for better understanding and compassion in managing gut-brain disorders.

Moving North: Building Foundations at Salford

Choosing to train in Salford under Professor David Thompson, Professor Paine found an environment uniquely suited to his interests — one that blended biology, psychology, and social science.

During his PhD with Professor Qasim Aziz, he explored sensory processing and pain mechanisms in the gut using cutting-edge techniques like transcranial magnetic stimulation with Professor Shaheen Hamdy and direct acid infusions into the oesophagus — sometimes volunteering himself as a research subject. This work highlighted the complexity of pain and laid the foundation for his future clinical and academic work.

Clinical Leadership: Creating a Specialist Service

Upon his appointment as a Consultant at Salford Royal, Professor Paine set about building a dedicated tertiary neurogastroenterology service. He championed a multidisciplinary approach, recruiting specialist nurses and embedding one of the UK’s first GI psychology services into gastroenterology clinics.

His research into centrally mediated abdominal pain (CAPS) resulted in one of the world’s largest clinical case series. He identified key clinical markers such as cutaneous allodynia and was an early advocate for avoiding opioid use in these patients, promoting safer neuromodulator therapies instead.

Research Highlights: New Directions in Pain Management

Professor Paine’s research demonstrated the effectiveness of duloxetine in treating neuropathic gut pain and supported combination neuromodulator therapies, aligning with international guidelines.

He is currently involved in the DUOLIPA study, investigating duloxetine for chronic pancreatitis pain, in collaboration with colleagues Joe Geraghty and John McLaughlin.

As Chair of the British Society of Gastroenterology (BSG) Neurogastroenterology and Motility Section, he helped lead national initiatives, study days, and contributed to several international guidelines, including on intestinal failure and motility disorders, irritable bowel syndrome and functional dyspepsia.

Emerging Challenges: Hypermobility and Feeding Escalation

Professor Paine discussed the growing clinical challenge of patients presenting with hypermobility syndromes — a new and complex patient group, particularly prominent in the UK.

He has worked with John McLaughlin and Prof Simon Lal to produce national guidance on the appropriate use of invasive feeding techniques, and recently contributed to a European-wide position statement on avoiding unnecessary parenteral nutrition in patients with neuromuscular and motility disorders.

Emerging research, including a multicentre UK survey, highlights that many hypermobility patients are being escalated to parenteral nutrition due to symptoms alone rather than true nutritional need, exposing them to significant risks. New national guidelines are under development to address this.

New Frontiers: Gut Microbiome, Chronobiology, and Eating Disorders

Professor Paine spoke of the rapidly evolving interest in the gut microbiome, describing it as “Doctor Strange in the Multiverse of Madness” — full of promise but also misinformation.

Recent collaborations have explored the interface between gut microbiota and circadian rhythms, investigating new biomarkers like faecal volatomes.

Another novel area is the emerging condition of “Restrictive Intake Self-Harm” — a form of disordered eating within the neurogastroenterology population.

Professor Paine has also led a recent pilot study using a novel blinded pump feeding model to differentiate centrally mediated from gut-driven symptoms . The early findings, presented at BSG, suggest this diagnostic tool could have major clinical implications.

Caring for the Carers: Addressing Burnout

Recognising the high rates of burnout within gastroenterology, particularly among those working at the nutrition-neurogastroenterology interface, Professor Paine and his team are pioneering reflective practice workshops for GI consultants. This initiative aims to provide psychological support to clinicians, with formal evaluation planned to measure its impact on wellbeing.