Professor Bryan F Warren

(15 April 1958 to 28 March 2012):

An appreciation

Bryan Warren, that most unique of gastrointestinal pathologists, died at home on 28th March 2012 at the cruelly young age of 53. It is a sad irony that he died of a complication of Crohn’s disease, a condition about which he was a world expert. He fought his intestinal cancer with remarkable stoicism for five years and would accept any treatment oncologists were prepared to throw at him, sadly, in the end, to no avail.

Bryan was born in Cheshire and was proud to have been educated in state schools in Nantwich. He read Medicine at the University of Liverpool. There he developed a great interest in gastroenterology, partly driven, no doubt, by his own diagnosis of Crohn’s disease in early childhood. Initially, he trained in gastroenterology in the North West and developed a particular fascination with endoscopy, something that paved the way for his remarkable reputation for integrating endoscopic appearances with those down the microscope and eventually led to him enlightening a generation of endoscopists. Luckily for his fellow histopathologists, MRCP exams were not his strong point and this ensured that he transferred to Pathology. How pleasing it was for Bryan, therefore, to be elected a Fellow of the Royal College of Physicians, without examination, twenty years later, in 2007. We know that was a very proud moment for him.

There were some real characters in Pathology on Merseyside in the mid 1980s and this ensured that Bryan was caught, hook, line and sinker. Later, his training was undertaken in Bristol, especially with Jack Davies and John Bradfield. He made some great friends in fellow trainees there, especially Howard Rigby, who was to remain a life-long close friend. Even as a trainee, he wrote seminal papers in Gastrointestinal Pathology, especially inflammatory bowel disease. He also started his research in comparative pathology, studying inflammatory bowel disease in cotton top tamarins. His humour always shone through in all parts of his work, not least in the development of an interesting and unique scoring system for assessing the severity of colitis in the tamarins....

Bryan was thrilled to be appointed Consultant Gastrointestinal Pathologist in Oxford in 1994. He was, above all, a clinical pathologist and was determined that he would never be what our old mentor, Basil Morson, called a "postal pathologist". Bryan spent hours in Endoscopy with Derek Jewell, Simon Travis and their colleagues. Further, the Department of Cellular Pathology at Oxford was perfectly suited to him because the operating theatres were immediately adjacent to his department, assuring that he could don his blues and go and quiz Neil Mortensen and his surgeon colleagues to his heart’s content. His collaborations with clinical colleagues were legion. He had a very close relationship with gastro-intestinal surgeons and physicians at Oxford and was one of the very few pathologists to be a longstanding member of the Association of Coloproctology. He was so proud to be made an Honorary Member of that Society in June 2010, receiving the award just two weeks after major surgery.

His teaching, training and writing outputs were remarkable, not least because his prime commitment was to diagnostic gastrointestinal pathology. And commitment it was. We knew that if we ever wanted to speak to Bryan at 9.00 pm, we just had to ring his office in Oxford. He would think nothing of reporting 8000 surgicals a year whilst pathologists elsewhere could barely scrape 2000.

His supreme talent was in teaching. He organised and facilitated seminal courses even as a trainee in Bristol, especially the "Cut-up course", then unique in UK pathology. Anyone who has sat in a Bryan Warren lecture will remember his style and his dynamism with particular fondness. He enjoyed, of course, cultivating his broad Cheshire accent, especially in Oxford, and had a unique way with words. "Ulcerative colitis goes up to where it stops", "Low power lens and high power brain" and "If you don’t know what it is, staring at it won’t help" are particular favourites of ours.

His reputation as a remarkable communicator meant that Bryan was always in demand to lecture worldwide. He was instrumental in establishing (under the auspices of the British Division of the International Academy of Pathology, the BDIAP) Pathology Schools in places of need, primarily in Bosnia (with the help of his great friend Mike Franey and Acorn Aid) and this remains as one of his many legacies to international pathology. Indeed, BDIAP Council has, this month, ratified a change of title of the Bosnian British School of Pathology to the ‘Bryan Warren School of Pathology’. Bryan welcomed innumerable clinical fellows from around the world to his laboratory in Oxford. He instilled in them the importance, above all, of practising in a clinical context (sometimes amazing them by visiting the wards to speak to patients!) and they all left with great affection and respect for him.

Although teaching, training and research were central to his professional life, he was also an administrator and organiser of consummate skill. He had little interest in NHS administration, but give him a conference to organise and he was away. He was Meetings Secretary to both the Association of Clinical Pathologists and the BDIAP and an elected member of the Pathological Society Committee. Always highly innovative, he also had a skill fairly unique in pathology, an ability to extract sponsorship money from organisations not so keen on dispensing funds to pathological causes. In 2010, the BDIAP awarded him its Cunningham Medal in recognition of his huge contribution to that Society. He also had major involvement of the British Society of Gastroenterology, having been an elected member of Council and served as both Chairman and Secretary of the Pathology Section of the BSG, the leading body for GI pathology in the UK.

Although highly important to him, Bryan’s life was not just about gastroenterological pathology. He had strong family bonds and our thoughts and prayers go out to Tracy, his wife, and to Scott and Emma, his step-children, to whom he was very close. Sadly his own dear mother predeceased him just one month before. Outside work, Bryan had an extraordinary enthusiasm for cars and for the process of driving itself. At any one time, he owned six or seven cars, including three Bristols, of which he was most proud. He was an active member of the Bristol Owners’ Club and the Institute of Advanced Motorists. Despite none of us considering cars to be anything more than a means of getting from A to B, Bryan would regale us for hours on end with the particular properties of various engine parts of which we had little or no idea. Bless his enthusiasm and his single-mindedness!

We will all miss his peerless enthusiasm and his extraordinary appetite for work. He leaves behind a vast legacy of original papers, chapters and books. The latter include important endoscopic-pathological correlation tomes and, of course, Morson & Dawson's Gastro-intestinal Pathology. Sadly, he did not live to see the final publication of the 5th Edition but that book will be surely dedicated to his memory. So many of his writings were composed in the singular way, direct and uncompromising, but always with clinical relevance. Bryan's academic contributions were recognised in 2009 by the award of an Honorary Chair from the University of London, of which he was immensely proud.

So many people have bemoaned his sad and premature parting to us, describing him as a "larger than life character". And he certainly was 'big-boned' but few knew the main reason for this. When he had such a voracious appetite, he could be fairly confident that his Crohn’s disease was in remission. Bryan was hugely admired for his intelligence, his dynamism and his extraordinary sense of fun here in the UK and internationally. We have all lost a great friend, a loyal colleague and a supreme intellect.

Professor Neil A Shepherd
Gloucestershire, UK

Professor Marco R Novelli
London, UK

Professor Geraint T Williams
Cardiff, UK