Causes, Treatment and Future Developments of Functional Gastrointestinal Disorders [Interview][Transcript]

Prof_Gerald_Holtmann_FGDs_APP2016Guest: Professor Gerald Holtmann
Presenter: Wayne Bucklar
Guest Bio: Professor Gerald Holtmann is the Associate Dean Clinical for the Faculty of Health & Biomedical Sciences and the Faculty of Health & Behavioural Sciences. In addition he is Director of the Department of Gastroenterology & Hepatology at the Princess Alexandra Hospital in Queensland. Prof Holtmann studied Medicine at the University of Essen, Germany and completed his Clinical Training in Medicine and Gastroenterology at the University Hospital Essen, Germany and the Mayo Clinic, Rochester, Minnesota. He is a Fellow of the Royal College of Physicians (London) and the Royal Australasian College of Physicians (Sydney). In addition to his training in Medicine and Gastroenterology, he completed a Master of Business Administration at the University of South Australia and is certified by the German Board of Physicians in Medical Informatics and Biostatistics.

Segment overview: In today’s Health Supplier Segment, we are joined by Professor Gerald Holtmann here to share information on IBS and FD, epidemiology, pathophysiology, causes, treatment options and future developments in the treatment of functional gastrointestinal disorders. He is hosting a Clinical Bites session at the Australian Pharmacy Professional Conference focusing on the causes and treatment of functional gastrointestinal disorders. Professor Holtmann is an accomplished and internationally renowned Academic Gastroenterologist, with particular research focus in the field of neurogastroenterology. In relation to the now widely accepted role of inflammation for the manifestation of functional GI disorders, his work in patients as well as in-vitro studies have pioneered this and he is considered one of the international experts in immune activation and disturbed gastrointestinal function.


Health Professional Radio – Functional Gastrointestinal Disorders

Wayne Bucklar: You’re listening to Health Professional Radio, my name is Wayne Bucklar and my guest today is Professor Gerald Holtmann. Professor Holtmann is the Director of Gastroenterology and Hepatology at the Princess Alexandra Hospital and Associate Dean Clinical Faculty of Medicine and Biomedical Sciences and Faculty of Health and Behavioral Sciences at the University of Queensland. Professor Holtmann welcome to Health Professional Radio.

Professor Gerald Holtmann: Hello.

W: Now I understand you’ve recently been a guest at a conference and speaking about some of the work you’re doing and some of the research that you’re doing. Can you tell us about what it was that you spoke about?

G: Well the topic I presented was functional gastrointestinal disorders, this is probably the most frequent condition that requires medical attention. And certainly the pharmacists are, is a frontline to provide advice and services to patients besides the GP’s and specialists.

W: I see. And it was a pharmaceutical conference you’re addressing, what was it that you told them?

G: Well functional gastrointestinal disorders are characterized by a broad spectrum of symptoms and in recent years the concept of these disorders have dramatically changed. While in the past it was believe they were simply “psychosomatic or stress related disorders” have now clearly predefined pathophysiologic mechanism that we can identify and frequently even treat.

W: Now recently we were having a conversation with another researcher in this area, has the knowledge based about this change so dramatically in recent years?

G: It has been significant, it started with better definitions the so called wrong definition of disorders that which clearly define what is required to diagnose functional gastrointestinal disorder or what is required to make it highly likely. So for symptoms need to be chronic or recurrent and then we categorize them based upon the predominant symptom that on this, somebody has more meal related upper GI symptoms, it’s most likely functional dyspepsia and if the symptoms are associated with alteration of bowel movement we refer to this as “irritable bowel syndrome.” And the pathophysiology has changed, as I said in the past it was sought this is simply psychosomatic stress related we’ve now recognized that many patients manifest with their symptoms after having for example an acute infection, and this infection happens maybe while on leave and having nice holidays but the symptoms then persist for months or even years and decades. Now for acute infections and inflammations can trigger the mechanisms that ultimately result in chronic symptoms.

W: Now I’ve been led to believe that inflammation has often been considered at the root of the disease, but some of the recent researchers suggested that maybe it’s “infection” that’s causing the inflammation. Is this been apparent in your research?

G: Well infection can cause inflammatory response and then the inflammation is the ultimate mechanism how … occur. And it maybe that there is single event of an infection and after the single event the immune system is change and respond with persisting immune activation which is inappropriate when you think about the underlying infection. On the other hand our gut is infected, therefore we’re hosting thousands of different bacteria and the composition of suspect fever probably regulate the immune response and this makes it even more complicated, our organism adapt to this bacteria and if we have a broad spectrum of bacteria we are expose to in the early childhood, it’s highly likely that we tolerate this bacteria. However if you’re exposed to bacteria in a latest stage of life, your immune response may cause trouble, therefore it’s a very complex interaction between infections, immune responses and actually time point when the organism is exposed to bacteria. Our data suggest that the density of the bacteria for example in the small bowel is related to symptoms and this is important because we know that some patients respond to antibacterial therapy, many patients with functional gastrointestinal disorder are treated nowadays for the helicobacter pylori infection.

W: Uh huh.

G: And there appears to be a small benefit, which is statistically significant runs about 5% of patients benefit. Interestingly if we look at the prevalent of the helicobacter pylori infection and the population and compare symptoms in helicobacter pylori infected subjects and symptoms in subjects who are not helicobacter infected there’s no difference. Therefore I was always wondering why do at least some studies showed improvement of symptoms and it might be it’s not the helicobacter pylori infections, but an unspecific effect of the antibiotic. Therefore these antibiotics change the microbiome in the gut, at least temporarily and this might be an important clue.

W: Professor Holtmann it is a fascinating area of research and I am delighted to hear that there are researchers like yourself who are making gains in this. But also in all sorts of fields I regularly have discussions with people who are concerned with the bacteria that we co-exist in our gut and their significance to our health, so I’m pleased that it’s an area of your research as well. Professor Holtmann we’ve talked to you about your conversation at the Clinical Bites Session, what other research are you undertaking at present?

G: At the moment we are very much interested to better characterize the microbiome of the gut in various patient cohorts and healthy controlled. And it’s not just the density, it’s the question what kinds of bacteria are available and these are typically bacteria which we cannot identify simply by culture. Therefore we need highly developed molecular technologies to identify them and bacteria in the small bowel colonize the very specific niche but in order to reach this niche in the small bowel, your devices for example an endoscope needs to go through the stomach or through the colon, and you will appreciate that this instrument then will be contaminated by bacteria which we find for example in oral cavity or in the stomach, therefore we develop techniques to obtain aseptic biopsies to study the specific microbiome in specific areas of the gut without cross contamination. And this hopefully will really advance this field and this completely different approach as compared to just looking at the bacteria which we find in the store.

W: Fascinating work indeed, it haven’t occurred to me that the contamination problem would occur and as soon as you mentioned it, is obvious. Professor Holtmann, I do thank you for your time today. If people are interested in getting in touch with you, is there a website where they can reach you?

G: There are information on TRI for Translation Research Institute.

W: Thank you very much for your time this morning. If you just joined me I’ve been in conversation with Professor Gerald Holtmann, Director or gastroenterology and Hepatology at the Princess Alexandra Hospital and Associate Dean Clinical, the Faculty of Medicine and Biomedical Science and Faculty of health and Behavioral Sciences at the University of Queensland. He’s been sharing with us his recent presentation regarding gastrointestinal disorders and his research regarding it. The good news is we have a transcript and we have an audio archive. So if you’d missed my conversation head off to the Health Professional Radio website, where you can access both the transcript and the audio archive on YouTube and Facebook. Professor Holtmann thank you very much for your time, I do appreciate it. It’s been good to have you on Health Professional Radio.

G: Thank you.

W: You’re listening to Health Professional Radio, thank you for joining us today. My name is Wayne Bucklar.

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