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

Follow us:

Twitter/X: https://x.com/2guystalkingit

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).