Two guys talking **it - A Gastroenterology and Hepatology podcast

#04: Professor Alex Ford - Navigating disorders of gut-brain interaction and IBS

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Jan 22, 2025

Professor Alex Ford, a leading gastroenterologist from the University of Leeds, dives into the complexities of irritable bowel syndrome (IBS) and its connection to the gut-brain axis. He discusses the challenges in diagnosing IBS, the role of the ATLANTIS trial, and how psychological therapies can enhance treatment. The conversation also touches on the significance of individualized care and the potential benefits of probiotics. Ford's insights on evidence-based approaches highlight the necessity of patient-centric treatment strategies.

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INSIGHT

IBS and Gut-Brain Axis Impact

IBS involves abnormal communication in the gut-brain axis affecting motility and pain signaling.
Symptoms can be as severe as in chronic diseases like COPD or stroke, impacting quality of life vastly.

ADVICE

Diagnosing IBS Positively

Use positive symptom-based diagnostic criteria for IBS with limited investigation.
Avoid unnecessary tests once bloods and celiac serology are normal to reassure patients and diagnose IBS confidently.

ADVICE

Managing Bile Acid Diarrhea

In IBS with diarrhea, test for bile acid diarrhea using CCAT scanning especially in patients with high BMI.
Trial bile acid sequestrants if test is positive but monitor for side effects like bloating and constipation.

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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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