Welcome back to the Curbsiders. I'm Dr. Matthew Wato here with my great friend, Dr. Paul Nelson Williams. Paul, how are you doing tonight?

Matt, we're talking H. Pylory. We're talking obesity. I'm here with my great friend, Matt Wato. What could be better? I'm doing fantastic.

Once again, Paul, it is a weeknight and late. We are recording a podcast. What more would I be wanting to do with my life?

When I was a seven-year-old child, my parents asked me what I wanted to do when I grew up. This was exactly what I described to them. Do the letters.

Things are coming up Williams.

Tonight, we were going to recap two fantastic episodes that were very practicing for me. We talked about H. Pylory.

Again, we're going to talk about obesity, medicines, and frequently asked questions. Paul, before we get to that, can you remind the audience who are we and what do we do?

Yeah, Matt. The internal medicine podcast, ordinarily we use expert interviews from Euclincol Pearls and Practice Changing Knowledge.

Some day already get sued for that. I should probably stop saying that. The tales from the curbside, where we recap two episodes that are in this case very loosely related. We sort of go through it and highlight the pearls that we thought were especially useful or meaningful.

In this case, we're talking about H. Pylory with Dr. Sephory and obesity medicine FAQs with Dr. Cody Stanford.

A lot of high yield stuff in both of these episodes. Matt, we're going to start with H. Pylory.

For these shorter episodes, we, to give ourselves a break, these are not CME available for CME. But the two episodes we're talking about were individually available.

So if you go to curbsiders.vcuhealth.org, then you can claim your free CME credit through VCU Health. And now with that episode 322, H. Pylory with George Sephory, this was produced and with graphics by the great Beth Garbatelli. Now Dr. Beth Garbatelli, Paul, I mean, you know, so proud.

She did it. She did. No surprises there.

All right, to start us off, Paul, I wanted to talk a little bit about the epidemiology of this because this is a lot of this was new to me. I thought H. Pylory is like, oh yeah, just throw some antibiotics at him for two weeks and you're done. Not that easy.

But H. Pylory mostly is a childhood illness. And it's in the US. It is here, not as prevalent as in some other places, but it's really a marker of like cramped living conditions and attends to spread through families just because the way that it's spread.

And it's a little oral route. So, you know, families get colonized with this, which makes sense. And that's one of the points that will come up with later about screening why you might screen people who are first generation from a country where there's a high high prevalence.

And Paul, I wanted to ask you like the symptoms of H. Pylory. We're going to talk about some maybe asymptomatic patients we might screen, but what makes you think about H. Pylory?

Well, I mean, before this episode or previously we've talked before about this, I probably lumped together GI symptoms or upper GI symptoms and to serve this one amorphous process that hopefully responded to proton pump inhibitors. So if you regard this whether you had heartburn symptoms or regurgitation or post-prone deol fullness or you know, apagastric pain, I just kind of hope that that would respond to the same medication.

And Dr. Sephory advocated for really doing your due diligence separating those things out into GERD versus dyspepsia when appropriate, because GERD, it's pretty reasonable to treat with a proton pump inhibitor empirically see how you do within kind of reassess your therapy.

Dispepsia should prompt you to do your H. Pylory testing. Dispepsia as a reminder are things like this, this post-prone deol fullness or the apagastric pain that happens after meals, that is more dyspepsia than a GERD type picture. So those, those things should make you think H. Pylory.

And then otherwise the symptoms tend to be relatively non-specific sort of GI stuff. You can have pain, you can feel kind of gassy, there can be loading and belching.

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