Summary

Dr Gideon Hirschfield is a leading expert in autoimmune liver diseases, including PSC, PBC, and autoimmune hepatitis. He’s helped shape how these conditions are understood and managed around the world, combining cutting-edge research with a real passion for patient care.

Today he discusses his work with autoimmune liver diseases, particularly primary sclerosing cholangitis (PSC) and autoimmune hepatitis. We discuss some key topics in PSC (including use of Ursodeoxycholic acid, cancer surveillance as well as the PSC/IBD phenotype), and Professor Hirschfield gives us a masterclass in the management of autoimmune hepatitis. He also offers advice for new hepatologists, highlighting the significance of clear diagnoses, individualized patient management, and clinical trials to drive us into the future.

As always comments, questions and feedback please send to: X: @2guystalkingit

Email: 2guystalkingit@gmail.com

Chapters

00:30 J & J Introduction

06:15 Introduction to Professor Hirschfield and Autoimmune Liver Diseases

07:41 The Role of Ursodeoxycholic Acid in PSC Management

19:06 Understanding the Pathophysiology of PSC

22:43 Cancer Surveillance in PSC Patients

28:39 The Relationship Between PSC and Inflammatory Bowel Disease

32:30 Vancomycin and PSC

36:28 Management Strategies for PSC and IBD Patients including Pouches

40:00 Management of Autoimmune Hepatitis: An Art and Science

56:30 Proactive Approaches in Primary Biliary Cholangitis (PBC) Management

1:01:05 Advice for Aspiring Hepatologists

Keywords

Hepatology, Autoimmune Liver Disease, PSC, Ursodeoxycholic Acid, Cancer Surveillance, Inflammatory Bowel Disease, Clinical Trials, Patient Care, Liver Transplantation, PSC Management, pouch studies, autoimmune hepatitis, management, PBC, hepatology, patient choices, liver transplant, treatment options, chronic diseases, clinical trials

This is a really special episode with an incredible doctor (Jon says "the best clinician I have ever met").

Today we welcome Dr Simon Gabe, an internationally renowned expert in intestinal rehabilitation. Dr Simon Gabe is a consultant in gastroenterology & intestinal rehabilitation at St Mark’s Hospital and chair of the NHS National Reference Centre for Severe Intestinal Failure at St Mark’s. This is also an Integrated Care centre for intestinal failure and a recognised ESPEN Training Centre. He has a wide clinical experience in dealing with complex nutritional problems, inflammatory bowel disease, fistula management, intestinal failure requiring enteral or parenteral support, home parenteral nutrition and consideration of intestinal transplantation. Dr Gabe is a past President of BAPEN. He co-founded the National Adult Small Intestinal Transplant (NASIT) Forum in the UK and has been an active member of a Clinical Reference Group within NHS England responsible for the development of a clinical network in England for all patients with Intestinal Failure (HIFNET). He currently co-chairs the HPN Clinical Advice and Management Group for NHS England.

As always comments, questions and feedback please send to: X: @2guystalkingit

Email: 2guystalkingit@gmail.com

Chapters

04:15 Introduction to Simon Gabe

06:59 Understanding Intestinal Rehabilitation

09:56 Defining Intestinal Failure

13:29 Trends in Intestinal Failure Causes

16:23 Bowel Length and Nutritional Support

20:26 Managing Short Bowel Syndrome

26:06 Barriers to Recognizing Intestinal Failure

30:37 Patient Evaluation Process for Intestinal Failure

33:07 Empowering Patients in Line Management

36:21 Managing Line Sepsis: Best Practices

43:17 Understanding Ehlers-Danlos Syndrome (EDS) and Nutrition

50:14 Nutritional Support in Cancer Patients

54:18 Enteral Support in Dementia Patients

57:15 Addressing Intestinal Ischemia: A Call to Action

Keywords

Intestinal rehabilitation, intestinal failure, nutrition, gastroenterology, patient care, bowel length, short bowel syndrome, nutritional support, clinical practice, healthcare, line management, line sepsis, Ehlers-Danlos Syndrome, nutritional support, cancer patients, dementia, intestinal ischemia, patient empowerment, multidisciplinary team, intravenous nutrition

Jon and James welcome Dr Beatriz Gros, a leading expert in inflammatory bowel disease (IBD). They discuss key findings from the recent European Crohn's and Colitis Conference in 2025.

Dr. Beatriz Gros (X: @bealoquebea Instagram: @dr.beatrizgros) is a consultant gastroenterologist based in Córdoba, Spain, specializing in inflammatory bowel disease (IBD). She serves as a Consultant Gastroenterologist at Reina Sofía University Hospital in Córdoba and has also worked as a Senior Clinical Fellow at the Western General Hospital in Edinburgh, UK. Dr. Gros has a particular interest in environmental factors associated with the development of IBD and predictors for disease flares, contributing to studies like the PREdiCCt study. She actively engages in medical education through social media platforms such as Instagram and Twitter, and is the creator of the educational website www.ibd-eii.com, which offers summaries of over 140 clinical trials and relevant IBD studies. Dr. Gros’ dedication to advancing IBD research and education has made her a respected figure in the gastroenterology community.

As always comments, questions and feedback please send to:

X: @2guystalkingit

Email: 2guystalkingit@gmail.com

Chapters

03:32 Introduction and Guest Introduction

05:30 Reflections on the ECCO Conference

08:10 Systemic antibody response predicting onset of IBD

13:12 Predicting Disease Onset and Flare Factors

13:45 The PREDICT Study and Its Implications

21:44 Dietary Insights and the Mediterranean Diet

23:30 The ADAPT Study on Emulsifiers and IBD

30:00 General dietary recommendations in IBD

33:48 Fiber consumption and Crohn's Disease development

39:40 The Role of Plant-Based Diets in IBD

43:18 Environmental factors in association with IBD

45:53 Understanding Environmental Factors in IBD

47:25 Linking IBD and Neurodegenerative Diseases and Vedolizumab

54:32 Proactive Monitoring in Ulcerative Colitis

Keywords

IBD, ECCO Conference, Bea Gros, PREDICT Study, Mediterranean Diet, Emulsifiers, Disease Prediction, Patient Care, Dietary Studies, Holistic Health, Crohn's Disease, Ulcerative Colitis, plant-based, fiber, environmental factors, probiotics, nutrition

We very excited about the episode today!

We are joined by A/Professor Jason Tye-Din - a leading expert in coeliac disease and immune-mediated gut disorders. He is Coeliac labratory head at the Walter and Eliza Hall Institute of Medical Research, a Mathison Centenary Fellow at the University of Melbourne, and consultant Gastroenterologist at the Royal Melbourne Hospital. His work focuses on the immunology of coeliac disease, novel diagnostic approaches, and developing non-dietary treatments. He is also one of the smartest (and nicest) clinicians that we have had the privilege of working with.

Joining Jason on the podcast today is Dr Cynthia Kanagasundaram. Cynthia is a UK trained Consultant Gastroenterologist with a vast experience in all things gastroenterology. She prides herself on innovation and has developed a novel GUT HUT service which slashed waiting times and improved patient care. She is embarking on a new stage of her career exploring novel diagnostics, techniques and treatments in Coeliac disease in the Tye-Din lab at the WEHI with A/Prof Jason Tye-Din as her supervisor.

Today we delve into the complexities of coeliac disease. We cover the diagnosis, dietary management, refractory celiac disease, models of care and future of coeliac.

The International Celiac Disease Symposium (ICDS 2026) will be held in Melbourne Australia 17-20 November 2026. Details at https://www.icds2026.org

Chapters

00:20 Introduction with Jon and James

04:42 Introduction to A/Prof Tye-Din and Dr Kanagasundaram

06:42 Understanding Coeliac Disease: Diagnosis and Patient Education

09:17 Dietary Considerations: Foods to Avoid and Oats Discussion

12:44 Biopsy Guidelines and Diagnostic Approaches

16:44 Revisiting Biopsy Techniques and Clinical Observations

19:40 Mucosal Healing and Follow-Up Practices

22:35 Refractory Coeliac Disease: Definitions and Management

26:48 Treatment Strategies for Refractory Coeliac Disease

31:14 Understanding Treatment Targets in Coeliac Disease

32:16 Maintenance Treatment for Refractory Coeliac Disease

33:13 Exploring Alternative Treatment Options

34:12 Balancing Treatment Risks and Benefits

34:59 Advancements in Histology and Scoring Systems

37:05 Future Directions in Coeliac Disease Research

39:01 Innovations in Diagnosis and Screening

41:01 The Role of Gluten Challenges in Diagnosis

43:14 Understanding the Causes of Coeliac Disease

45:14 Patient Management and Follow-Up Care

48:12 Vaccination and Hyposplenism

56:13 Opportunities for Research and Collaboration

Links to papers mentioned

Iron deficiency.(Link)

2020 ESPGHAN Guidelines for diagnosing Coeliac Disease

Clinical and Immunologic Features of Ultra-Short Celiac Disease. (Link)

A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease.(Link)

Diagnostic outcomes after gluten challenge in adult patients with unconfirmed coeliac disease already on a gluten-free diet: A 20-year retrospective cohort study.(Link)

AGA Clinical Practice Update on Management of Refractory Celiac Disease: Expert Review. (Link)

Open-Capsule Budesonide for Refractory Celiac Disease. (Link)

Budesonide Induces Favourable Histologic and Symptomatic Recovery in Patients with Non-responsive and Refractory Coeliac Disease When Given in an Open Capsule Format. (Link)

Stool Gluten Peptide Detection Is Superior to Urinary Analysis, Coeliac Serology, Dietary Adherence Scores and Symptoms in the Detection of Intermittent Gluten Exposure in Coeliac Disease: A Randomised, Placebo-Controlled, Low-Dose Gluten Challenge Study. https://doi.org/10.3390/nu16020279

Impaired IgM Memory B Cell Function Is Common in Coeliac Disease but Conjugate Pneumococcal Vaccination Induces Robust Protective Immunity. (Link)

Professor Alex Ford is a renowned researcher in Gastroenterology, specializing in Disorders of Gut-Brain Interaction (DGBIs). Based at the University of Leeds, he has authored numerous high-impact studies on conditions like irritable bowel syndrome (IBS) and functional dyspepsia. With a focus on evidence-based treatments and advancing our understanding of the gut-brain axis, Professor Ford is widely recognized for his contributions to both clinical practice and academic research.

Summary

In this conversation, we interview Professor Ford about his work and insights into Disorders of Gut-Brain Interaction (DGBI). Alex explains the complexities of IBS, including its diagnosis, the role of the gut-brain axis, and the impact of symptoms on patients' quality of life. He discusses the diagnostic criteria for IBS, the significance of bile acid diarrhea, and various treatment approaches, including the use of gut-brain neuromodulators. The conversation also covers the ATLANTIS trial, which investigated the efficacy of amitriptyline in treating IBS in primary care, and touches on the concept of neuroplasticity in relation to long-term treatment effects. We go on to discuss the complexities of managing Irritable Bowel Syndrome (IBS), emphasizing the importance of psychological therapies, the nuances of treatment sequencing, and common mistakes made in IBS management. Professor Ford highlights the need for evidence-based approaches, the role of probiotics, and reflects on his academic career, stressing the importance of mentorship and the ability to discern valuable opportunities in one's professional journey.

Chapters

03:00 Introduction to Alex Ford and His Work

05:04 Understanding Irritable Bowel Syndrome (IBS)

11:22 Diagnostic Criteria for IBS

14:05 The Role of Bile Acid Diarrhoea

18:44 Treatment Approaches for IBS

20:06 The ATLANTIS Trial and Its Findings

30:07 Neuroplasticity and Long-term Effects of Neuromodulating agents

37:47 Neuromodulator titration and Psychological Therapies in IBS41:59 Sequencing Treatments for IBS

48:45 Common Mistakes in IBS Management

55:34 Probiotics: Evidence and Recommendations

59:56 Reflections on an Academic Career

Articles discussed:

ATLANTIS Trial: https://www.thelancet.com/article/S0140-6736(23)01523-4/fulltext

Probiotic meta-analysis: https://www.gastrojournal.org/article/S0016-5085(23)04838-2/fulltext

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Every podcast is incomplete without a 'best of' episode from the previous year. In this episode Jon and James talk about their big learnings / seminal papers / themes of 2024 in Gastroenterology and Hepatology.

We wish we could have included more!

As always, please leave questions/comments either below or on our X (@2guystalkingit).

Episode #02: Checkpoint conversations

In the first full episode, we tackle the rising challenge of managing colitis and hepatitis triggered by immune checkpoint inhibitors. From recognizing these entities to exploring (non) evidence-based management strategies. Join us for a conversation packed with insights, or if you just want to hear Jon try and pronounce 'nomenclature'.

Please leave any questions, comments, or suggestions either on our twitter feed (@2guystalkingit) or below. We will try to answer any listener questions on the next show.

Hello world..

Welcome to Two guys talking **it - a podcast designed for gastroenterologists and hepatologists or anyone interested in the field. Each week, join Jon and James as we bring you expert discussions, the latest research, and practical clinical insights amongst a lot of talking **it..

In this episode we briefly introduce the podcast. Bear with us as we try to work this thing out!

Please leave any comments or requests for future episodes, or catch us on twitter (@Jonathansegal85 or @JamesHaridy)