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

A/Prof Jon Segal and Dr James Haridy
  • 5.0 (4)
  • Medicine
  • Updated Biweekly

“Two Guys Talking $#it” is a podcast where two Gastroenterologists break down complex topics into engaging, educational, and occasionally humorous conversations. From liver health to gut microbiota and everything in between, A/Professor Jonathan Segal and Dr James Haridy deliver insights, share the latest research, and discuss clinical pearls with the odd guest in tow. Comments, suggestions, questions please contact us on twitter @2guystalkingit or leave a comment below..

  1. 3d ago

    #14: Professor Nick Talley: Dyspepsia, Duodenums and the Trouble With "Functional"

    Professor Nick Talley has spent 35 years building the field of neurogastroenterology, and he'd like us all to stop saying "functional". He is one of the global top medical researchers, a distinguished Australian gastroenterologist, and educator known for his seminal work on neurogastrointestinal disorders and co-authoring classic clinical examination textbooks. His argument is that the label sends patients and doctors looking in the wrong place. A lot of these people don't have a brain problem, they have a duodenal one, and he makes the case for a term he prefers: neurogastrointestinal disorder. From there he takes us through the pathophysiology his group has spent years building, subtle duodenal eosinophilia that ordinary pathologists aren't counting, an abnormal duodenal microbiome, and food antigens setting off an immune response that eventually becomes self-sustaining. Then the practical stuff. Why he biopsies the duodenum, why he reaches for antihistamine blockade, why amitriptyline and not nortriptyline, when mirtazapine is the right call, and what he does when everything has failed. Plus when a gastric emptying study actually changes anything, why lactulose breath tests are not helpful, his approach to cyclic vomiting, and a reminder that rumination is not vomiting. Keywords: functional dyspepsia, DGBI, neurogastroenterology, duodenal eosinophilia, eosinophilic duodenitis, gastroparesis, Rome V, amitriptyline, microbiome, cyclic vomiting, SIBO, breath testing, Nick Talley As always comments, questions, feedback and suggestions please send to: X: @2guystalkingit Email: 2guystalkingit@gmail.com Chapters00:19 Intro 03:32 Welcome Nick 04:22 What functional dyspepsia is, and why it's probably several diseases 06:48 Rome V, and why "functional" is a terrible word 08:14 How Nick explains the diagnosis to patients 09:00 Workup and first-line treatment: scoping, routine duodenal biopsies, PPIs, tricyclics, antihistamines 13:21 Adding an antihistamine on top of a PPI 13:49 Duodenal eosinophilia: can your pathologist actually see it? 15:43 EoE and functional dyspepsia: separate pathways 17:03 Six-food elimination, biologics, and the budesonide trial 19:28 The duodenal microbiome and swallowed streptococci 22:20 Refractory disease: mirtazapine, SNRIs, quetiapine, hypnotherapy 26:01 Smoking, alcohol, NSAIDs, exercise and diet 29:08 Exclusive enteral nutrition 30:02 Gastric emptying, gastroparesis, G-POEM and rumination 33:50 Cyclic vomiting syndrome 36:39 Why amitriptyline and not nortriptyline 37:51 Breath testing: what's useful and what's worthless 40:39 What Nick is excited about in the next five years 44:11 A weird and wonderful therapy for IBS 46:27 A career in academic medicine 50:42 Why pharma abandoned DGBI 52:16 Wrap-up

  2. Jun 12

    #13: Jon and James - GLP-1s: From Lizard spit to liver fibrosis

    We're back for Season 2, and Jon and James kick things off with one of their favourite topics: Incretin mimetics. The gut is the biggest endocrine organ in the body, and the data in steatotic liver disease is now as good as anything we have in Hepatology for steatotic liver disease. James and Jon cover the basic pharmacology, how to start and titrate these drugs in practice, what to tell patients about stopping them, the muscle loss question, endoscopy and anaesthesia, and a brief look at where the evidence is going across cardiovascular disease, kidney disease, sleep apnoea, IBD, and cancer. There is a lot going on with these drugs and this episode is the primer. As always comments, questions, feedback and suggestions please send to: X: @2guystalkingit Email: 2guystalkingit@gmail.com Chapters00:00 Intro: Season 2 is here 03:00 What are incretins? The gut as endocrine organ 06:30 Origin story: Gila Monster and the GLP-1 breakthrough 08:30 The drugs: semaglutide, tirzepatide, and what's coming 10:00 How they actually work: satiety, the brain, and fat oxidation 12:00 Who to start: patient selection and caution groups 13:30 Lean MASH and Southeast Asian BMI thresholds 16:00 Exercise, muscle loss, and the resistance training argument 18:30 Side effects: nausea, constipation, lipase, mood 21:00 Endoscopy and anaesthesia: what to do 24:00 Titrating in practice: James's approach 28:00 Stopping the drug: weight regain and the SURMOUNT data 33:00 Personalising treatment: who can stop, who shouldn't 35:00 Eating disorders, body image, and screening 37:00 MASH data: ESSENCE and Synergy-NASH trials 39:30 Oral formulations: what's available and caveats 40:30 Where bariatric surgery still fits 42:00 Broader indications: IBD, CVD, CKD, cancer 45:00 Global obesity trends and the public health message 47:00 Wrap-up Papers discussedESSENCE trial Synergy-NASH trial SURMOUNT-MAINTAIN Tirzepatide and fat oxidation, Cell Metabolism 2025 GLP-1 receptor agonists and 13 obesity-associated cancers SELECT trial FLOW trial SURMOUNT-OSA STEP 9: Semaglutide in obesity and knee osteoarthritis Psoriatic Arthritis paper

  3. Jun 8

    #12: Season 2 Trailer

    We're back. After a longer-than-planned hiatus involving life, work, and the general chaos of being two busy clinicians: Two Guys Talking $#it is returning for Season 2. The spark? Jon got stopped in a hospital corridor by a non-gastro colleague who'd been listening to the IBS episode with Alex Ford and had shared it with her neighbour. Turns out the show has fans in unexpected places, and that was enough to get us back in front of a microphone. Season 2 kicks off with one episode a month and a lineup that already has a few things in the works. Same format, same vibe, no Backstreet Boys cover. Glad to have you back. As always comments, questions, feedback and suggestions please send to: X: @2guystalkingit Email: 2guystalkingit@gmail.com

  4. 07/29/2025

    #11: A/Prof Elliot Tapper - Liver legends, lies and lactulose

    Today we had the privilege of talking to a true superstar in the world of Hepatology. Elliot B. Tapper MD is an Associate Professor in the Division of Gastroenterology and Hepatology at the University of Michigan. He is Academic Chief of Hepatology. His primary goal is to empower patients to enjoy a high quality of life. He is an expert in the management of chronic liver disease, performance of clinical trials, and big data for the study of liver disease. He has developed strategies that reduce symptoms and improve quality of life and invented tools that have helped keep patients with cirrhosis at home and away from the hospital. He is the Editor-in-Chief of Hepatology Communications. In this episode, A/Prof Tapper discusses his journey in hepatology, the impact of social media on medical education, and his innovative research on muscle cramps and pickle juice. He debunks common myths surrounding methotrexate and liver disease, explores the complexities of ammonia levels in hepatic encephalopathy, and shares insights on frailty in liver disease management. The conversation also touches on the evolving perspectives on antibiotic prophylaxis in cirrhosis and the critical importance of diagnostic paracentesis. Elliot emphasizes the positive aspects of hepatology and the exciting developments in the field. As always comments, questions and feedback please send to: X: @2guystalkingit Email: 2guystalkingit@gmail.com Chapters 05:08 Introduction to Elliot and His Work 08:14 The Power of Social Media in Medical Education 11:10 The Fascination with Pickle Juice and Muscle Cramps 14:00 Innovative Research During COVID-19 17:01 Exploring Non-Pharmaceutical Interventions 20:04 Debunking Myths Around Methotrexate and Liver Disease 23:10 Addressing Misconceptions About Medications 25:56 The Impact of AI on Medical Literature 28:56 The Ammonia Debate in Clinical Practice 30:17 Understanding Ammonia as a Clinical Biomarker 37:28 Assessing Frailty in Liver Disease Patients 44:20 Reevaluating SBP Prophylaxis in Cirrhosis 49:03 The Importance of Diagnostic Paracentesis 52:34 The Positive Side of Hepatology Keywords Elliot Tapper, hepatology, liver disease, medical education, social media, muscle cramps, methotrexate, ammonia levels, frailty, antibiotic prophylaxis, diagnostic paracentesis

    #11: A/Prof Elliot Tapper - Liver legends, lies and lactulose

  5. 07/09/2025

    #10: A/Prof Gianluca Ianiro and Dr Benjamin Mullish - The gut microbiome in health and disease

    Today we’re talking bugs, bowels, and breakthroughs with A/Prof Gianluca Ianiro and Dr. Ben Mullish, two microbiome maestros who make poo science strangely fascinating. A/Prof Gianluca Ianiro is an Associate Professor of Gastroenterology at the Università Cattolica del Sacro Cuore in Rome and a Consultant at the Gastroenterology Unit of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS. His clinical and research interests center on the gut microbiota, with a particular emphasis on fecal microbiota transplantation (FMT) and its applications in gastrointestinal disorders such as Clostridioides difficile infection and irritable bowel syndrome. Recognized as a leading expert in his field, Professor Ianiro has contributed extensively to international consensus guidelines and has been acknowledged for his work with the United European Gastroenterology Rising Star award. He also leads the Microbiome Clinic at Gemelli, translating cutting-edge microbiome research into clinical practice.  Dr. Benjamin Mullish is a Senior Clinical Research Fellow in the Division of Digestive Diseases at Imperial College London and an Honorary Consultant in Hepatology and Gastroenterology at St Mary’s Hospital, part of the Imperial College Healthcare NHS Trust. He is also an IPPRF Research Fellow within the Department of Metabolism, Digestion and Reproduction at Imperial College. His research focuses on the gut microbiome and faecal microbiota transplantation (FMT), particularly in the context of liver disease and gastrointestinal infections.This conversation delves into the complexities of the microbiome, particularly the gut microbiome, and its significant role in health and disease. We discuss the dynamic nature of the microbiome, the challenges in microbiome research, and the potential for microbiome-based therapeutics. They also explore the roles of prebiotics and probiotics, the future of microbiome diagnostics, and the potential future concept for specialised microbiome clinicians to bridge the gap between research and clinical practice. As always comments, questions and feedback please send to: X: @2guystalkingit Email: 2guystalkingit@gmail.com Chapters 00:20 J + J Introduction 05:11 Introduction to the Microbiome   07:16 Understanding the Gut Microbiome   10:04 The Dynamic Nature of the Microbiome   13:21 Factors Influencing the Gut Microbiome   16:15 Clinical Relevance of Stool Microbiome   19:24 Microbiome and Disease: Cancer and Liver Health   22:12 Microbiome in Inflammatory Bowel Disease (IBD) and Metabolism   25:20 Future Directions in Microbiome Research   35:20 The Uncertainty of Microbial Therapeutics   37:10 The Future of Microbiome Research   42:41 Understanding Prebiotics and Probiotics   56:49 The Need for Microbiome Clinician specialists

    #10: A/Prof Gianluca Ianiro and Dr Benjamin Mullish - The gut microbiome in health and disease

  6. 06/05/2025

    #09: A/Professor Emma Halmos & Dr CK Yao - Food is Medicine.. or is it?

    Today we welcome two world-leading dietitians to talk all things diet in IBD and IBS.... A/Prof Emma Halmos is a senior research dietitian at Monash University and the Alfred Hospital. Her scientific achievements have had a major impact in clinical practice nationally and internationally. The most notable was the pivotal feeding study that demonstrated the low FODMAP diet was efficacious in patients with IBS. A/Prof Halmos has been elected onto the D-ECCO (Dietitians of European Crohn’s and Colitis Organisation) committee and is a leading coordinator for the first ECCO guidelines on nutrition in IBD. Her current role at Monash University is leading research on novel dietary therapy to treat IBD and IBS. Dr CK Yao is a senior research dietitian at Monash University and the Alfred Hospital, and recent NHMRC emerging leader. In 2017, CK completed her PhD investigating dietary manipulation of gut microbial function and the application of gaseous biomarkers in patients with functional and inflammatory bowel disease. Dr Yao currently leads a research programme looking at optimising dietary strategies for patients with ulcerative colitis and those with an ileoanal pouch.We discuss the critical role of diet in managing inflammatory bowel disease (IBD), particularly Crohn's disease and ulcerative colitis. We explore various dietary patterns, the impact of emulsifiers and ultra-processed foods, and the importance of personalized dietary advice. We talk about the significance of dietitians in guiding patients towards healthier choices. This conversation delves into the complexities of dietary recommendations for various gastrointestinal conditions, particularly focusing on the Mediterranean diet, Crohn's disease, and IBS. We discuss cultural influences on diet, the importance of personalized nutrition, and the emerging trends in dietary therapy. Finally we touch on the new ECCO Diet in IBD guideline that is set to be published soon. As always comments, questions and feedback please send to: X: @2guystalkingit Email: 2guystalkingit@gmail.com Chapters 00:00 Introduction with J & J 4:20 On to our guests... Diet and IBD 05:50 Dietary Patterns for Disease Prevention 08:53 Therapeutic Diets and Active IBD 11:58 Controversies in Dietary Recommendations 15:02 The Impact of Emulsifiers and Ultra-Processed Foods 18:07 Practical Dietary Advice for Patients in IBD 21:02 Cultural Considerations in Dietary Recommendations 23:57 Food as Medicine: A Discussion 27:03 Exploring Diverse Dietary Patterns 30:13 Conclusion and Future Directions 32:26 Cultural Influences on Diet and Health 34:40 Dietary Recommendations for active Crohn's Disease 37:22 Understanding Pouch Patients 38:11 Initial Assessment for IBS Patients 44:25 Screening for ARFID 48:03 Emerging Dietary Trends in IBS 51:40 New Guidelines in IBD Nutrition Papers discussed Fitzpatrick JA, Gibson PR, Taylor KM, Anderson EJ, Friedman AB, Ardalan ZS, Smith RL, Halmos EP. Clinical Trial: The Effects of Emulsifiers in the Food Supply on Disease Activity in Crohn's Disease: An Exploratory Double-Blinded Randomised Feeding Trial. Aliment Pharmacol Ther. 2025 Apr;61(8):1276-1289.  https://pubmed.ncbi.nlm.nih.gov/39967287/ Fitzpatrick JA, Gibson PR, Taylor KM, Halmos EP. Development of Novel High and Low Emulsifier Diets Based upon Emulsifier Distribution in the Australian Food Supply for Intervention Studies in Crohn's Disease. Nutrients. 2024 Jun 18;16(12):1922. . https://pubmed.ncbi.nlm.nih.gov/38931276/ Halmos EP, Gibson PR. Controversies and reality of the FODMAP diet for patients with irritable bowel syndrome. J Gastroenterol Hepatol. 2019 Jul;34(7):1134-1142. https://pubmed.ncbi.nlm.nih.gov/30945376/ A FODMAP Gentle approach: https://www.monashfodmap.com/blog/gentle-fodmap-diet/ The SCOFF Questionnaire: https://ceed.org.au/wp-content/uploads/2024/05/SCOFF.pdf

    #09: A/Professor Emma Halmos & Dr CK Yao - Food is Medicine.. or is it?

  7. 04/28/2025

    #08: Professor Gideon Hirschfield - The Art and Science of PSC and Autoimmune Hepatitis

    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

    #08: Professor Gideon Hirschfield - The Art and Science of PSC and Autoimmune Hepatitis

  8. 04/07/2025

    #07: Dr Simon Gabe - Rebuilding the gut: Intestinal rehabilitation

    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

    #07: Dr Simon Gabe - Rebuilding the gut: Intestinal rehabilitation
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“Two Guys Talking $#it” is a podcast where two Gastroenterologists break down complex topics into engaging, educational, and occasionally humorous conversations. From liver health to gut microbiota and everything in between, A/Professor Jonathan Segal and Dr James Haridy deliver insights, share the latest research, and discuss clinical pearls with the odd guest in tow. Comments, suggestions, questions please contact us on twitter @2guystalkingit or leave a comment below..

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