You think Makin India program is visible in the railways? Yes sir. Can you give some evidence? Yes sir. Two in particular sir, one is the locus. We have a joint venture in the railways, joint venture with Alstom and GE for two loco plants, for GE for diesel plants, diesel plant and with Alstom for electric engine plant. So that is one. One is the Vande Bharat Express or Trinity and that has been indigenously developed, that is a trail set and it is entirely new technology for India. So two by I think. Conversion of a diesel to loco to electric, that also is some kind of an achievement. So it is an incremental achievement, but still such incremental improvements are up to big improvements in London. So where is this as Tom planned? So one is in Mathepura and the other is in Mahabharava, but I am not sure which one is. Yes. Good. Mr. Dubey, you want to climb Mount Everest? Yes. When I wish you all the very best. Thank you sir. Have you heard of a man called Sonam Bangal? I don't know. I don't know. I think I remember. I think you climbed Mount Everest from the Indian side and who was Bachindari Paal? The first woman to climb Mount Everest. Now taking off from your aspiration to climb Mount Everest, the government has a scheme of aspiration this week. Yes. What is the scheme? It is a scheme to transform the basic infrastructure and social infrastructure, particularly health, education and roads and other infrastructure in 15 most backward districts of India. These districts have been selected based upon a composite infrastructure index and at least one district from each state has been included. The aim is to, it aims at the convergence of different programs. It fixes responsibility and accountability through the library officers and it focuses on the saturation approach in those districts. Now out of these 150, 35 have been designated as LWE affected districts. How many of these LWE affected districts are there in Jharkhand? Sir, I am not entirely sure, but 19 LWE affected districts are there. Tell me something about this LWE, why is it that it is continuing after almost over 50 years and it first started? How is it that it is able to sustain itself? Sir, although the LWE incidents in Jharkhand in particular have reduced, I think the main reason is that the improvement in social and economic indicators are slow and above in progress. So there are always and in Jharkhand particularly there are some pockets in which the development is slow and in such pockets LWE elements are able to exploit some sort of resentment against the establishment to their benefits. So are there any special initiatives which have been taken by the Jharkhand government in this respect? Sir, in collaboration with the central government it has many schemes, for example the SRE. That is going on for quite some time. Sir, the road requirement plan was there, but sir I see and based upon my personal visit to my native places in Jharkhand, a huge thrust on predominantly Gram Sarajevo. So Jharkhand is actually constructing around 2500 kilometres of roads. Even in the Naxal affected areas? Yes. Are they being allowed because in the past in Naxal were attacked the teams that should go into that area? In fact, yes. In fact, for example, I came from Palamu which used to be a huge Naxal infested. And there sir, the Gram Sarajevo class and it has actually brought positive change in the social environment. Because once connectivity is there, the biggest problem is that in most of these areas there is no connectivity at all. Now have you heard of extradition? Yes. What is extradition? Extradition is the physical repatriation of a person to his country of homicide or in the homicide. Right. Now we have several cases, I mean from the UK, from the UAE. Can you recall any persons who have been brought from UAE recently? In the Augusta-Westland case? Yes sir. Yeah sure. It's a Christian Michelle. Christian Michelle is one of them. And the other is a person called Rajiv Saxena. He was in the news very recently. Did you read over it? Yeah. Basically he says that he wants to turn approval. And he is slated to go before the United States court I think probably day after or something. There is this regional connectivity scheme of the government. Yes sir. All around. Can you tell me something? How does it work? Yes sir. So, sir, India has a peculiar problem where in such big metros are very well connected by flights. Whereas small and non-biological airfields are not. Udaan is an initiative to connect those partner airfields to bigger cities through a central viability air funding. So, that is one component sir. And the key component is the splitting. Various airlines wait for VGF from home on that particular route. Half of the seats in those flights are capped 25 minutes per hour of flying. And rest the airlines are allowed to set market price. Okay. Thank you. It's a good way. You are here now. Yes sir. I'll ask you one question. The dynasty has been talking about a new India. Yes sir. There is vision for a new India. This will be your probation and you will be the builder of this new India and we will be including his vision. Now, if you ask me, then I can ask you. Suppose what is my vision for the new India? I will say three things and I'll justify each one of them. One is no alcohol. Ginger jargon beer is no alcohol. No non-vegetarian food. And third is no corruption. If you ask me, what is your, what kind of India, three things that you would like me in India to have, which is dramatically different from what it has been so far? Sir, may I take a few moments? Yeah. Sir, the first would be, sir, educated and skilled India. Second is healthy and long-living India. And third is, sir, progressive India, sir, social as in getting rid of all the mass and all the conservatism that is counterproductive. What is healthy India? How do you implement it? Sir, the vision is, sir, everyone, it's the vision of everyone having an assured access to quality health infrastructure in his vicinity. Sir, Ayushman Bharat and Health Coral is one step in that direction. Sir, it particularly hinges on access to sub-centers in the laboratory that have good practitioners available that, for example... Would you like to introduce yoga in each school as a comprehensive subject? Yes. Now, coming to educated India, what is the new thing that you would like to do? Sir, extensive use of ICT in learning and immersive learning, sir, so that, so as to arise the interest of children, getting them hooked onto the subjects being taught. Would you ban mobile in India? In the schools, to all schools in India? Right. During classroom hours, sir? Yes. But otherwise, at the home? No, sir. Not often. Otherwise, in the school premises, no mobile. Yes, sir. I think it's a fair restriction, sir. Anyway, think of it. You know, you may have found this kind of question. Now, look at the new India. Central public sector undertakings. We have been building in the old India. How many are there? Yes, sir. Sorry, sir. Exact number. I'm not able to read all. Sir, on to operating year 250. Now, what is, what role that CPSC would play in the new India? We have been building, right? Yes. 60 years. Now they are 250 odd numbers. Would you like all of them to be dismantled? Are you going to build more? Sir, build more if needed. Sir, the existing ones, improving their efficiency, sir. It should not be that they are a drain of public money and taxpayers' money is going on indefinitely and funding sick and unviable PSUs. In such cases, I would actually suggest closing them down or reviving them. Otherwise, those who are profit-making and making healthy profits, expanding them further, sir. Would you like to have a hospital under the public sector? Yes, sir. If it is providing good level of service, if it is catering to poor people and providing good quality healthcare, then yes, sir. Okay. Now, coming back from New India to Old India. There's some scheme called crop incidence scheme. Yes, sir. PM has announced it in 2016. Can you say a few things on that? Yes, sir. Sir, the scheme is called Pradhan Mantri Pasambilmayur. The aim is to increase the penetration of agricultural insurance from about 25% in 2016 to 50% in three years. And the new things in that scheme versus the older scheme is it covers a wide range of new, for example, natural disasters and farm inundation and post-harvest damage. So that is one. Secondly, sir, the premiums are fixed. Premiums payable by the farmers are fixed. For rubbing crops, 1.5%, the rest is born by the... Only 2%. Only 2%. Thanks, sir. The rest will be born by the central government. It is being implemented by various state-run general insurance companies. But one critical element in that is the use of technology. Yes. Extensive use of technology, sir. Yeah, drone technology and also remote sensing data. For what? For example, sir, for assessment of damage for instance. Yes. And for making the payment of the damages faster for the farmer. Do you think it is possible to have an accurate assessment of the damage with this technology? Sir, while having an accurate assessment may not be possible, sir. Even based on rough estimate, good extractions or initial payment could be released and final payment could be done based upon the actual ground level assessment by surveyors. That also helps the farmers a lot. Especially when, sir, many checks that have been dispersed are less than 100 rupees and so, mainly because the assessment was not done. Okay. Tell me how... When will you get the data about beggars in the country? How many beggars are there in Jharkhand? Sir, about Jharkhand, I am not sure. But I remember, sir, reading about 10 lakhs in the cold country. But, sir, I am not certain. In the 12th land of India. And how many senior citizens are there? Yes, sir. Sir, about 11 percent of the population, that is about 15 percent. But, what you mean is your hobby? Yes, sir. You just said that sparrow sightings have become very rare, especially in Indian cities. Why is that so? No, one is the increasing unplanned construction and concrete temples. There are very little green spaces for them. No, it's not green spaces because sparrows build in buildings. So, you know those Jharokas are more there, a way to do that. Yes, sir. All right. And the bullet train is going to take away from the Thanik week. Yes, sir. So, even there the land for the flamingoes is being taken away. Yes, sir. Yes, sir. What I recall, because a portion of the craft passing through the Thanik, the flamingoes and Jharkhand, would be under water, man. Some ocean might be on land. But, man, in such cases, railways should ensure that the deforestation should be minimum. For example, man through elevated corridors imposed above the canopy. Now, swimming is also your hobby. Why is it that we don't have any swimmers on the international level? First and foremost, man, the absence of good quality infrastructure. In some metro and other cities, there are many goods, man. But, as we go down through here to three cities, and as you check what is the infrastructure, it is not present. Secondly, when I am asking the person who pointed out, there is a critical growth of role models in swimming. So, for example, he says that cricket has many role models, and now it is suddenly picking up. But, swimming lacks. The person has lots of sponsors, not just the role models. All right. Now, you are from Jharkhand. Jharkhand is very rich in resources, but poor in administration. Why is that so? Development is very poor. Yes. One reason has been the political instability and discontinuity policies, man. But, now that Jharkhand has a stable government, we do see sides of good pickup in development. For example, if I would say, in the instance, between NFHS-3 and NFHS-4 in those 10 years, 2006 to 2016, the women's literacy has improved by 21 percentage points. Man, in fact, the IMR improved for Jharkhand is now better than the national average. For the national average, Jharkhand is better. So, there are definitely, as I pointed out, grants like Jharkhand is making lives better for people at the grassroot. And these are a few instances. So, I mean, finally, we are seeing the fruits of the development, although we have a lot to do. So, you think it was a good move to buy potato state of Jharkhand? For Jharkhand, yes. Jharkhand looks good. Now, tell me something about the rate-based. The operating cost of the rate-based is very, very high. Yes. Of rating ratio, something like 4 and 9 ratio. So, why doesn't the rate-based monetize their land? Well, in fact, it's a very good suggestion. And, for example, the rate-based product committee and NKVPC also noted this. Now, Railway has a body of rate called Rail Land Development Authority, RLA, that has been implemented to at least develop the lands and increase the revenue flow from them. Hypergram, yes, it has been very slow. A part of it should be monetized through sale or lease, and second through redevelopment. So, the Mumbai Railway Land, which is available, that has been given for one week reconstruction? Yes. Okay. Now, tell me, do you think Railway should be credit-based? No, not in entirety, but some portions. Like what portions? Now, for example, what the rate-based development committee suggested, Railway becomes a credit-based company. So, maybe the core functions and? And we also become one of the clean operators, and clean operations being also open to our private sector. So, that way, it increases the competition, it makes an addition of revenues, and customers also will be championed with it. You mean the traffic services? Yes, ma'am. So, what are the main causes of accidents in the lead case? Ma'am, as the wonderful Railway minister recently pointed out, 60% are due to track failures. Track failures. Track failures. Other causes being unrandom crossing. But now, we have recently... We said that there will be no more line, except in the narrow range. So, in the broad range network, we have said, entirely eliminated. So, that will also... Secondly, ma'am, also the negligence of the customers, for instance, particularly in Mumbai locals. Although, ma'am, the available infrastructure there is not enough to carry the entire passenger. And, ma'am, accidents on the railway crossings due to negligence of the driver. Can you talk something about Railway 18? One day, please. Now, is it the same technology used in the Bombay? No, ma'am. It's broadly used. So, why are we calling it the new sustainability? It's not the new sustainability. The train set, while similar to the EMU, it has entirely different performance characteristics. EMUs are designed for different 1-2-kilometre stops, fast acceleration and deceleration. Railway 18 is designed for better college and better speeds. Basically, it's the same model as the same technology. Yes, ma'am. It's train sets are an improvement over the EMUs. Thank you. Mr. Dubey, you worked in the corner sector for about five years, more than every moment I guess. The last time, then also, I think, in one of the corporate sector.  So, can you talk about the biggest problem in the current sector? Sir, the problem... Sir, actually, dual balance sheet problems. First, balance sheets are stressed and non-performing assets are increasing due to which the ending capacity is going down, due to which corporate balance sheets are also starved of capital. Yes, sir. Have you seen many difference? Yes, sir. Not to the extent we would have to see, but, sir, as again pointed out in the budget speak, as the other member of the finance minister mentioned, there are three backwards of investments, either having resolved or resolved in one way or another. Yes, sir. If you realize that the process is very slow and, I think, a lot of mitigations. Every second day, I think you come across some new mitigations in this. Sir, there are various strategies. First, it's a force, sir, so it's a compendium of various laws, and we are still in the process of fine-tuning implementation machinery. At the same time, sir, as the RxPdence with the old bankruptcy and immigration process includes, definitely, sir, there would be an improvement in the turnaround time process basis. A lot of cases are coming to the economic crisis, ICC events, PNB. What are your take on that? Is it the reasons? The reasons, yes. They are in the private sector. Yes. Sir, a major reason is a lack of proper checks and balances, like evolution of powers to subordinates without having accountability for something PNB-based. Corporate governance? Yes, at a broad level, it is a failure of corporate governance, set up in those corporations. Has anything been done to strengthen corporate governance in this country? Yes. There are no companies, I mean, companies, sir. Also, sir, recently, the Adi Kodrej panel and the Kodrej panel, upon it, I said we do. Which of the critical areas in corporate governance, according to you, we have some difficulties? For example, the voice of minority shareholders, and that leads to, sir, independent directors not being actually independent, in the sense. Insider trading also, I think, very recently, I was reading it in the newspaper. Sir, it is also working? Sir, it is also working. Yes. And somebody who is never here in the corporate sector, who has chance with insider trading, and she has to pay penalty, some of them, he and some of them. He paid penalty of 10 lakhs for insider trading. He imposed it, sir. Okay. Here comes Hartan. First, he's coming for a lot of criticism, the implementation. What is your take on? Sir, yes, as the... the... ...that has been pointed out earlier, presently, Hartan for instance, the grant of individual title, in Palama, for the rest of the decade, it is as high as 90%. So that is actually a good number versus what in India average is less than 20%. So yes, individual titles, chapter particularly has done well. So community titles as we pointed out are slow to be given to the private communities. Oh sir, last question. What are the very important summits meeting in Hanoi? Sir, the aim was to extract some commitment from North Korea about re-improvisation. Although such a commitment could not be extracted and we could not decide. What was it that North Korea was looking for? They wanted US to... Sir, one more positive thing that they actually managed to get is that US has committed that it would be going out of state with South Korea. Although sir, it was looking for security guarantees and I mean a broader integration than we were going before it proceeds on the internet. OIC. What was it in the news? Sir, the honorable National Affairs Minister addressed the summit of the OIC as a special invite and raised India's rights and services between... Did you just agree with the development? Yes sir. What is the height of Limanjaro? Sir, 5,895 meters.  So, are you mountaineer? Not in the true sense sir, but trekker and all myself. That would be able to go to that height. You must have some practice and training. Sir, I did some preparation rights including sir, 100 kilometers, trekking, Sikkim, Westman, all the way to the region. But some mountaineer in the true sense, then I am able to climb on their best. Then you have done trekking in Westman hearts and Malayas helps. Which one was the most involved? Malayas. Malayas. Why? Sir, the variety of landscapes. For example, recently sir, I did one Indrahaar past. Now, when we start it is dense jungles around the road bench. As we go by its barren, tropical dense, finally sir, as we have gone the past, there are no vegetation, it's rocks and boulders and finally there is snow at the summit. So, within a span of 3 days and while gaining around 2500 meters, one sees a lot of diversity in landscape and vegetation. Now, I am giving you an idea. DFCs are being created and land is being acquired for them. Most of the land has been acquired. The plan is that by 2020 they should both DFCs should be complete. Plenty of land must have been acquired on both sides. After all it will be double tracks. Sir, one portion of the eastern DFC that would be a single track. That is between Lothiana and Kojava. But western is a double track. Now, instead of making this bullet train from Bombay to Angawa, why couldn't we acquire more land and run a bullet train on the western corridor? Sir, it's a land and you run it. Why couldn't we do that? It's a parallel to the DFC. Yeah, parallel to not on the DFC. Sir, in fact, acquire more land when you are acquiring so much. And that could be a more sensible thing. Long distance instead of this three hour journey. Sir, in fact it's a good idea. Sir, only day before yesterday it was in news that nine more bullet train vehicles have been identified. One of them being Angawa detail. Yes, sir, it should be done. Secondly, sir, Angawa to Mumbai is just a demonstrator of the idea. But that is successful, sir. It will have a cascading effect and we will be seeing more such high speeds. I doubt we don't have money. So big ideas mostly on paper. Sir, leveraging international finance to various multilateral bodies, given that it has a... Like once this is successful, it may be possible. And what about, say, in 10, 20 years India would be a level definition. We would have internal resources. Basic structure concept. Name some important basic features which cannot be changed. Sir, democratic quality, socialism, secularism, federalism. Structure, separation of powers. Independence of the nation. These are the improvements. These are all minor things. Now, our constitution is supposed to be rigid and flexible as far as the movement is concerned. Where does the rigidity come from? Rigidity comes from those amendments which affect the federal quality and limited provisions. There's an approval by both the houses of parliament, by a special majority, and a concurrence of a majority of states in the United States. Any other source of rigidity? It's not given in the constitution. Basic structure concept provides it. I'll take it to an even of the constitution. Meaning was qualitatively changed after the Menka-Gali judgment. And due process of law concept. Can you define what is the due process of law? So in due process, not only should the laws should be procedurally correct, but also, sir, they could be just of their intents that they should not. Quality, sir, I'm mixing. The emphasis on process, that means not only the law must be just unfair, but the process must also be just unfair. Which means it must follow principles by which a decision is made. What is the growth rate? Sir, last year, sir, funded out by the Economic Survey, last year it was 6.6%. In million terms, the projected in 18, 19 is 6.6%. Last year it was 4.6%. Sir, there is a bit of difference on this thing. Sir, there is one document from the Government of Punjab surprising that mentions 4.6%. But Economic Survey recommends 6.6%. No, sir, we have a few mistakes. That 17, 18 was 6.6%. Yes, sir. So we close the interview and I'll give you the feedback. You have performed well. Most of the questions you have been able to handle nicely. We feel the questioning will be based on it, primarily on the wire data. And therefore, you are from Jharkhand. This is one area which evokes some questions. There have been some allegations of starvation deaths. PDA system, not worth the analysis. It's possible some questions. Then you've been asked about respiration mistakes. What is the progress? Then left-wing extremism. These are all really good. Then management, another area. Your extracurricular activities are very impressive on which you should respect questions. Electrical, we haven't asked. But India's power generation. Various schemes like rural electrification, sub-hacke scheme. How they are going. These are some areas which we feel are. And lastly, two more things. One is the railways. Second would be constitution principles and important judgments of Supreme Court. And then current activities. These are some of them. You were asked a question about crop insurance. Now it's not only the government insurance companies, but also private. And for instance, reliance. And reliance has come to adverse notice in Maharashtra. In two, three districts like Burkhani. They are not paying the crooks. So Hassan Bima is not really working well.  They just don't pay. And Hassan says so. But what are the regions? So these are the areas where you can continue to study. Otherwise you will do something. But you will get outside. That's the best. Don't forget to like, share and subscribe to our channel. And press the bell icon to never miss an update.


Hi there, welcome back to my YouTube channel. This is Daniel Rossell here. Now I've done a couple of videos today on the whole subject of functional dyspepsia, which is also known as FD. Now I've been really, really struggling since I had my gallbladder surgery two years ago. As it must be said, a decent amount of post gallbladder removal patients are with just a whole boatload of digestive problems. And probably the toughest of these to treat or fix has been functional dyspepsia.  Now to the best of my understanding, the functional part means that there is no obvious physical or organic abnormality that explains the symptoms. The ones I've been having are what's called post-prandial functional dyspepsia. Now that from the Latin means after eating a meal. So after I eat, I'll get bloating and fullness and I'll feel like I'm sort of pregnant. And it's not a lot of fun and it's been going on for two years. So I have been seeing my own gastroenterologist trying to push for answers in the process of trying to fix this unpleasant problem. I came across a functional dyspepsia community on Facebook, a Facebook group. And they're very active, great community. I will put a link in the description. More recently, I started to look for scientific papers. Do doctors actually understand what FT is? Are there treatments coming along in the pipeline? And once I began doing so, one name kept recurring in every scientific paper I read. And that was a professor, Nicholas Talley.  And he has done extensive research into gastroenterology, very, very seasoned researcher and doctor, one of the leading voices in gastroenterology research. And his, one of his main areas is in the brain gut connection and in FD. So I decided seeing as he had done a couple of other videos on YouTube, I shot a professor Talley an email to see if he might be interested in having a chat with me to attempt to get a bit of clarity for other FT patients on exactly what doctors understand about this condition and what might be coming in the drug development pipeline. So without further ado, here's our chat. Okay, so we are joined by Nick Talley from Australia. So Nick, firstly, thank you very, very much for taking the time to have this conversation. I know that for a lot of people with functional dyspepsia, this is going to be invaluable because there's still just a sparsity of information out there on the internet, or that's my perception anyway. So you've been involved in the Rome Foundation, which I would love to mention also, because I know not a lot of people or at least there are some people who I believe don't know what exists with this condition. I'd love to get your, your take on, I guess, where the research is now. Because again, we kind of feel that there is unclear exactly what's happening. There's a lot of confusion regarding treatment and people's doctors trying different SSRI drugs and amitriptyline and the other drugs. And much, much, much confusion, I think, is probably the best way to summarize it.  So yeah, I just love to hear what you have to say about all this. Well, look, thanks very much for the invitation to join you. And I appreciate that. And I hope this will be of some value to people who suffer with this condition or their families, because this is really common functional dyspepsia, at least one in 10 people around the world. So remarkably common. And what's exciting is I think the research really is advancing in this field. We're starting to understand what's going on in functional dyspepsia. I think the word functional is going to be discarded by the next Rome iteration of the criteria for diagnosis because it's not functional in many, many cases. It's really almost certainly related to some pathology in what's called the small intestine. So where to start? Well, very common condition. We know how to diagnose it. So people present with feeling uncomfortable, full, bloated after they eat. Often there's a bit of pain as well, not always, but often in the sort of stomach area. And it can be quite distressing. Some people can live with these symptoms. It's not too bad. Other people are really distressed, really affects them. It's pretty severe. And, you know, it's an important condition first to diagnose and also to manage. Normally when we look down into the stomach in the upper part of the small intestine, it looks normal, which led to this concept of, well, there's some problem with the muscles or the nerves or the motor function or the sensory function, but there's no real pathology going on. That was the story that people believed for nearly 100 years. But we now know that when you take samples, tissue samples, when you look down with an endoscope, you can actually find evidence of pathology, particularly in the upper small intestine. And that's been the exciting shift in thinking because once that was discovered, and I'm very proud of my group because we really put this on the map, once this was discovered, we recognized that this inflammation, a special kind of inflammation, probably was related to the symptoms, certainly related to the damage you see that the small intestine's leaky, which is one of the abnormalities. We know the nerves get damaged probably from the inflammation that's occurring, and that means we have a target or targets to provide some treatments that really might make a difference. We also know the bacteria in this part of the gut, the small intestine, is disturbed. There is a change in the bacteria, and that's also probably important in the condition. And sometimes people develop this after a bout of gastroenteritis. You know when you get really crook after you have a bad meal, something you've eaten that's really got infected with something, or you catch a bacteria and you get vomiting and diarrhea and become really unwell for a couple of days, that's acute gastroenteritis, and that can set off functional dyspepsia. So it's an exciting time in terms of this condition, because not only can we diagnose it now, but we have pathology and we have new treatments. That's very exciting. To hear that, I mean I think that's encouraging as well for people who kind of feel like there is either it's a dustbin diagnosis, I think it is the common way to describe it, and it's great to know that there is that. Do you think that kind of understanding of where you and your research group are with functional dyspepsia has trickled down to your average gastroenterologist or do you think there's still a lot of sort of misperceptions amongst family doctors and you know perhaps more regional gastros about functional dyspepsia still being psychosomatic and all that? Well I mean we discovered this pathology in 2007, or that's when we published it, but it's taken a long time for people to start to accept and for other studies to confirm some of our initial observations. It always does when you have a big change in thinking, but it's now starting to trickle down, it hasn't trickled all the way down, don't get me wrong, but it's starting to trickle down and these ideas are starting to become more accepted and the approaches are starting to change slowly. But I can take you through the treatments that we have available right now and what works and what doesn't and I can take you through some of the emerging treatments that we are likely to see very soon. So I'm happy to do that, but clearly the good news is you know this condition is common often debilitating condition often a very chronic condition to it you know it stays with people for long periods of time. The good news is we see a real way forward and ultimately with luck cure for this condition is I think on the horizon which is very very exciting. Amazing. Just before we do get into treatments I just want to one quick question. So there's two sub types or from what I understand a functional dyspapsia the epigastric pain syndrome and the post-prandial distress and do you think the distinction between those two types in terms of the underlying pathology let's say and treatment approach is very different or is it really kind of different manifestations of one disease? So it's a little bit complex. The post-prandial distress syndrome is this syndrome where if you eat something you get crook you get unwell you get fullness bloating discomfort pain sometimes that's post-prandial distress syndrome and that's where the pathology that I just described that inflammation in the small intestine is most strongly linked. There's another group with epigastric pain that's stomach pain just below the breastbone and that group is is more complex it's a much smaller group it's not always related to eating it's probably a different condition actually but that is a much less common syndrome than the post-prandial distress group. That's actually extremely interesting because in this Facebook group I mentioned I think the epigastric pain or the people with a lot of pain complaints are over represented so I wonder if the people with the kind of bloating just kind of put it down but as you say it can be incredibly incredibly debilitating. I love that word crook as well by the way I presume it's an Australian word I'm going to have to have to start very Australian. Okay so yes I guess let's get into treatments in terms of what we have at the moment in terms of the treatment options and I guess what's coming in the in the drug development and research pipeline. So look first-line therapy and it's been first-line therapy for quite some time ever since we did some clinical trials on this are proton pump inhibitors these are acid suppressing medications often used for reflux disease for heartburn for example for peptic ulcer disease so you know a common group of drugs commonly use but what's really interesting is that they work in functional dyspepsia no doubt about that and what's really fascinating is their anti-inflammatory they reduce this small intestinal inflammation that you see on those biopsies and we believe based on the accumulating evidence that in fact the reason they work is because they suppress this inflammation not because they're acid suppressing medications so that would be first-line therapy and the proton pump inhibitor safe drug relatively can be used long term if required can be used as needed not long you know not every day but as needed which is also also works for some people there can be side effects any drug can have side effects but relatively safe compared to many medications that we use so that's a good drug to start with and I always start with that drug not everybody responds there's no doubt about that you know some people do not respond so that's what you do first first line for medication if that fails your next medication that you can think about is what's called a prokinetic drug a drug that accelerates the movement of material from the stomach and the small intestine and there is some evidence some people with these symptoms will respond to this group of drugs there are many different prokinetic drugs around the world the problem is the benefits are relatively small and the drugs available around the world very very significantly so it depends on which country you're in to what's available so in Australia very limited options in the United States very limited options in Asia more options we can come back to that but that's a group of drugs that are used and can be helpful as an additional therapy sometimes you add that on to the proton pump inhibitor drugs another option is what's called an antidepressant drug now this is not being used for depression this is being used to help the gut work better and have less sensation going in the wrong direction because one of the problems with this condition is the gut's very sensitive and these drugs are meant to tone down that sensitivity the the best evidence is it's with a very old class of antidepressants in low doses non antidepressant doses called the tricyclic antidepressants so amitriptyline is one of those tricyclic antidepressants and in low dose well tolerated safe relatively and some people find the marvellous therapy some people really respond very very well some people do not respond it's it's unfortunately a little bit hit or miss but it certainly certainly does work some of the other antidepressants the evidence is less clear that they really have a benefit for example the selective serotonin reuptake inhibitors prozac one of those doesn't doesn't work it doesn't work in functional dyspepsia whether you're depressed or not depressed it doesn't help the stomach symptoms so i think that's important to recognize there are some certain other drugs certain other medications that can help some people and we use those sometimes as as additional therapies so that's the drug side of it but i want to emphasize to people diet probably makes a real difference and that's because we believe foods set off this syndrome in some people actually probably drive the inflammation in some people so diet is a very important understudied component so what kind of diets may work a gluten-free diet works for some people we need to understand that better we don't know a lot about it but it seems to help some people some people will use an elimination diet certain foods that they eliminate but there's actually some evidence that again gluten nuts fish and a few other things milk products eliminating those can really help some people's symptoms and lead to relief and then finally a diet that's low in what's what I call fermentable carbohydrates what I call FODMAPS can help some people as well so we don't know as much about diet in this condition we're really beginning to learn it but there's no doubt diet can help and seeing an expert dietitian or a nutritionist can be very beneficial for some patients and I send almost all my patients to a dietitian to help manage the patient with me so diets important medications can help and then stress reduction helps some people as well probably stress aggravates the symptoms doesn't cause them but if you're really under a lot of stress it can be helpful to deal with that issue as well and we believe that the inflammation may be one of the drivers of increased anxiety in some people with this condition that they have increased anxiety and that's actually driven from the gut and that's a really important new piece of information as well absolutely fascinating this idea of this kind of two-way process between gut syndromes causing let's say you know psychological or psychiatric complications and vice versa those being bad for the gut so if somebody wants to find and I don't want to sort of make this about myself but that's kind of what it was for me it started with these gut problems then that can become very very depressing as people find it harder to exercise and do all these kind of you know common health mental health suggestions so if you found somebody in functional dyspepsia who was who had let's say a developed depression or anxiety as a result of this condition would your approach also be to use those older tricyclics or you know to go for the SSRIs and SNRIs and the more modern psychiatric drugs so I mean normally I it depends on the situation obviously if there's if there's depression if and people do get depressed I mean lots of people get depression it's a very common common problem then that needs treatment and we will treat that with one of the newer drugs for example that treats depression as part of the treatment approach if there isn't depression per se then we will probably use something like the tricyclics you know to help settle things down while we're also working on the dietary approach and perhaps some other treatments that I just talked about some people do need combination treatments because they've got a a long-standing dysfunction of their gut and it takes quite a while for it to get back into into into more normal patterns and that's just the way it is okay um so yeah and that's what we do there is some evidence that also you can treat the microbes in the gut that are probably relevant to this condition so you can suppress microbes and we we know that there's a use of what's called a non-absorbable antibiotic a drug called rifaxamen can be helpful for some people with this condition and we do use that sometimes probiotics less evidence about benefit probably there is some in some cases but we're not quite sure what the best probiotic is so that makes it a little bit complex to to treat that okay is there any evidence any connection between this small intestinal bacterial overgrowth soluble unfunctional dyspapsia or is that not really being no there's good evidence that people with functional dyspapsia have increased small intestinal bacterial overgrowth we don't know if that's a primary condition in other words whether the bacteria are driving the syndrome or whether it's related more to the fact that the muscles and nerves don't work properly and that means you get bacteria growing more than you would expect but we certainly recognize the association um and uh there's more work going on to sort out which bacteria specifically may be relevant that's a lot of what we're doing now we've got very exciting work ongoing in this space with the goal of course of treating bacteria that really matter and specifically targeting those to relieve the syndrome and i think we're going to see some really interesting approaches there in the very near future um one one of the interesting questions i got from facebook and i know i know i know your uh your time is short we need to talk about the the drug pipeline but just one very quick one if i may uh is there a connection between functional dyspapsia and autoimmunity so the answer is almost certainly yes interestingly so we've done some work in this um we know that associations of functional dyspapsia include a topic diseases like asthma and allergic rhinitis um and that was a little bit of a surprise no one had really found that before but there's absolutely no doubt about those associations and a weaker association but still important with autoimmune diseases rheumatoid diseases in particular and we we we don't fully understand that linkage but we suspect that again there is um auto antibody production probably from the inflammatory process that's what we suspect is going on are possibly driven by the bacteria that i'm i'm talking about that may change so if that's true and that's a hypothesis we're still testing and and following um that's really exciting as well because it might imply we might be able to treat certain autoimmune diseases as well through the gut so again pretty pretty stimulating stories are coming out from the work being done okay so in terms of what's in development so this drug that i uh wrote to you in an email i kept coming across and i think a paper you wrote you wrote akotiamid i'm not sure that's the correct pronunciation that and other drugs what what are things looking like in terms of what's coming down in the pipeline so akataya mines are very interesting drug it's available in japan and india only to the best of my knowledge at the present time it's been tested in clinical trials it is able to do something that's very important it relaxes the stomach which actually allows that feeling of fullness and uncomfortableness and and pain to sort of settle right down um and we think the reason the stomach doesn't relax properly is the small intestine affects the stomach and that's why the stomach doesn't relax so the drug works by not working on the small intestine works on the stomach and it's fairly effective um the clinical trial suggests some people will even get complete symptom resolution it'll go away the symptoms not everybody it's a small number but those who do do very very well so it's a good drug i don't have any clinical experience with it myself as it's not available to me in australia or in the united states um but it's certainly a drug that i think may end up coming more becoming more widely available and it seems to be reasonably well tolerated which is again a good a good piece of information to have so that's a new drug relatively new that is actually available in some places there are other drugs that target the inflammation in the small intestine turn off the inflammation and so there are some really interesting new drugs that can literally just switch it off and they look very very promising not only for the inflammation but also for the symptoms that people develop with this syndrome a lot of work going on in this area a number of companies are working to develop drugs that will follow this line um and i think that looks very exciting particularly for people with really severe functional dyspepsia where you know that's the group you target these drugs to in my view okay and i mean i guess that the million dollar question for sufferers is obviously there's a clinical trial process there is the process of fda approval ema approval these things sound wonderful but how long is it going to be before our local gastroenterologists can take out his prescription pad and write us up our acotia meter or a small a small intestine modulators so look i think it does take a little while for these things to work through the system so it takes some years to get through a clinical trial program there is a clinical there are a couple of clinical trial programs underway right now a couple of really quite close to finishing so that is exciting because that could lead to earlier approval you know because they're already well advanced but it depends on the results of those studies of course to see where they end up so i think we're a little way away from that in the meantime repurposing drugs already available is work that we're doing and other groups are doing to see whether we can make a difference with drugs already that are available and again don't forget diet is a very important piece of this and uh that's uh cheap safe and available so again very important for people to recognize there is a lot of overlap in the group between people you know suffering from GERD and IBS and these other conditions do you think the there's any link between these two and is there a connection it's almost certainly there is a connection people with functional dyspepsia are more likely to have irritable bowel syndrome particularly the diarrhea subtype of irritable bowel syndrome more likely to have gastroesophageal reflux disease with bad heartburn and sour taste acid taste coming up and damage to the esophagus we know they're linked but what's really interesting is this small intestinal inflammation looks like it's one of the drivers for some of these patients with these other conditions and what's exciting about this is that means we may have some new treatment options for these diseases too and that's an enormous number of people around the world who might benefit from new approaches so we're very excited about this idea that because we know what's going on at least in some patients with functional dyspepsia we might be able to make a real difference perhaps even a curative difference to patients with other conditions that are also remarkably common and burdensome. Why thank you Nick Nicholas so thank you very very much for your time I think just on behalf if I can speak for other people with FD I know that this interview or I hope this interview is going to be tremendously appreciative just to know that there is an understanding a growing understanding in terms of what's causing this treatment options is very encouraging so thank you very much for taking the time today to share your clinical experience and your research experience with me today. So Daniel thanks very much for having me it's been a great pleasure I hope my comments have given people some hope if nothing else about this condition and related conditions it's really exciting you know you know what what what excites me in particular is the idea that we get we're making advances that may change practice and make a real difference to people and patients so thank you very much. Thank you very much Nick so that was my chat this morning with Professor Larius Nicholas Talley through and through Australian and one of the leading research gastroenterologists in the entire world so it was an amazing privilege to be able to ask him some questions about functional dyspepsia and I just have to say that listening back I just spent the last hour editing that interview not nothing was taken out just editing pauses and I think there is a great deal of scope for hope in Professor Talley's comments just in terms of various ways if you're also really struggling with FD and maybe not getting answers from your doctor that dietary interventions a few different drugs to be tried and for those for those of us not in Japan or India hopefully not so much longer left to wait before those those newer drugs that are more directly going to treat FD are going to come to market so that's definitely room for hope there as well thank you very much to the functional dyspepsia Facebook group for sending in questions I unfortunately didn't have time to ask Professor Talley every one of those but I hope that for FD patients this was useful I just want to say one very very personal thing close to my heart because we did talk about psychiatric comorbidity and all that kind of stuff and I just would say that the last two years dealing with this has been so so mentally challenging and I would just encourage anybody to get help in that respect if they need it because there's often a feel that if you do that you're kind of admitting it's all in your head or even if your doctor seems to take that attitude that's not a good reason not to get help if you need it because I it's it's all going to help and it's all related and Professor Talley's research into that called Brain Connection has just kind of elucidated that so thank you guys for watching and and hopefully more videos coming out about FD on this channel at some point in the future