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Kathy Oxtoby examines how independent pharmacists can support patients to maintain good digestive health and help them relieve the symptoms of gastrointestinal conditions...

Pharmacists play a key role in supporting patients with digestive health concerns, says Laura Wilson, Royal Pharmaceutical Society (RPS) director for Scotland.

“They help ensure medicines are taken correctly, identify and manage adverse drug reactions – especially in patients on multiple medications – and guide individuals on the safe use of over-the-counter (OTC) treatments for common issues such as heartburn, indigestion, constipation and diarrhoea.”

She says pharmacists can also offer advice on lifestyle and dietary changes that can help alleviate symptoms and help patients identify personal triggers that may worsen their condition.

They are also trained to spot ‘red flag’ symptoms that may indicate a more serious underlying issue, ensuring timely referral to a GP or specialist.

“Many pharmacies offer private consultation rooms, allowing patients to discuss sensitive digestive concerns in a comfortable and confidential setting,” she says.

Maintaining good digestive health and avoiding digestive problems

Community pharmacists can give patients advice about maintaining good digestive health and avoiding digestive problems.

“Pharmacy teams should advise that customers avoid foods that exacerbate symptoms - for example, high-fibre foods during flare-ups - and suggest a well-balanced diet rich in nutrients to prevent malnutrition. They can also recommend eating smaller, more frequent meals instead of large ones,” says Kenny Chan, lead information services pharmacist at Numark.

“Pharmacists can advise that when eating, to do so slowly, chewing food properly, and drinking sufficient fluids throughout the day, (limiting the intake of caffeinated, fizzy and alcoholic drinks). Ensure adequate daily fibre intake and reduce the amount of fat in the diet. Other recommendations can include quitting smoking, taking regular exercise and managing stress,” he says.

“Pharmacy teams should also be encouraging regular physical activity to improve bowel function and reduce stress. They can suggest techniques such as mindfulness, yoga, or cognitive behavioural therapy,” says Mr Chan. 

People can follow information from the Food Standards Agency about good food hygiene and safe food storage as this can prevent food poisoning - which can be a cause of IBS.¹ They can also follow healthy eating advice from Guts UK.²

Pharmacists help people relieve the symptoms of gastrointestinal conditions. “Patients should be directed to see their GP if symptoms last more than three weeks or they are severe,” says Julie Thompson, information manager at Guts UK, the national charity for the digestive system.

Constipation

“The first line of treatment for constipation should always be lifestyle advice before laxatives are considered, as this also has additional health benefits,” says Ms Thompson.

Recommendations are to consume 30g of fibre a day from a wide range of wholegrain carbohydrates, fruits and vegetables.

She says a good level of fluid intake is also important, generally six to eight cups per day, but people’s individual needs may vary. Exercise can also help with constipation, and the NHS generally advises to do at least 150 minutes of moderate intensity activity a week, says Ms Thompson.

Vitamins and mineral supplements "should not be given as a treatment for constipation, as they could have other systemic effects, and better laxative options are available with more robust clinical evidence of effectiveness”, says Ms Thompson.

Constipation treatment preparations available based on minerals are Milk of Magnesia or Epsom salts – these are magnesium based, which are also available in ‘supplement’ tablet form. Milk of Magnesia and Epsom salts are reported for use to relieve occasional constipation.

“They could also be considered as a one-off treatment, with a suppository, to get things moving, when waiting for other treatments to start to work,” says Ms Thompson.

In respect to natural supplements, “this depends on the evidence base of the preparation and there needs to be research to back up the effectiveness of the products”, says Ms Thompson. “For constipation, products containing psyllium and beta glucan - found in oats and barley - have the best level of evidence as natural fibres to improve bowel function.”   

Stomach pain/cramps in digestive conditions

Buscopan is an OTC treatment, although use in severe constipation and ulcerative colitis is contraindicated, says Ms Thompson. Mebeverine can be used, but this is contraindicated in constipation in paralytic ileus, she says.

Diarrhoea

Loperamide is an OTC remedy, although this is contraindicated in people with severe diarrhoea after taking antibiotics or a flare up of ulcerative colitis, says Ms Thompson. For antibiotic associated diarrhoea there is some limited evidence for use of probiotics, she says.³

Persistent nausea and vomiting

Symptoms should always be referred to a GP for investigation, says Ms Thompson. Bismuth subsalicylate could be considered for short term use (two days), for nausea.⁴ “There are prescription-only options for treatment, for example antiemetics, but this symptom does require investigation,” she says.

Bloating

Products containing simethicone and peppermint could be used, says Ms Thompson. Probiotics are another option in people with IBS - these should have evidence of effectiveness for the condition, she says.³ 

Pain relief

In terms of pain relief, paracetamol based products are advised as anti-inflammatory products such as ibuprofen could worsen symptoms, says Mr Chan.

“After any gastrointestinal condition, it is advisable to drink plenty of water and use rehydration sachets to replace any fluids and salts that may have been lost,” he says.

As to what extent do unhealthy diets drive digestive diseases, “there is not much evidence to suggest this for a wide range of digestive symptoms and diseases. Diet is very challenging to research,” says Ms Thompson.

“Probably the best evidenced examples are a lack of dietary fibre causing constipation, and the recent publication of the National Diet and Nutrition Survey (published June 2025) suggests that people in the UK are still not reaching the advised target of 30g per day and are some way off reaching it,” she says.⁵

Another dietary factor, where there is stronger evidence is the consumption of red and processed meat being a risk factor for bowel cancer, says Ms Thompson.

Ms Wilson says encouraging healthier eating patterns is “a key part of preventative care, and pharmacists are well-placed to support patients in making informed choices”.

New targeted medicines for inflammatory bowel disease

The development of targeted therapies for inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, is “advancing rapidly”, says Ms Wilson. Recent innovations focus on therapies called biologics and immunomodulatory drugs - these are small molecules that exert their effect on specific immune pathways.

“Pharmacists working in hospitals and out-patient clinics play a valuable role in the management of these medicines for inflammatory bowel disease, working within multidisciplinary teams to ensure the safe, effective and personalised use of these therapies,” says Ms Wilson.

Guts UK is funding research into T-Cells and their role in developing Crohn’s disease in some individuals who are genetically disposed to it. “The research will measure types of T-Cell, and look for genetic variations in how these cells behave and how that affects risk,” says Ms Thompson.

The researchers are also using an antibody called basiliximab, to see if this can change the behaviour of these cells, where it has been found to be problematic. “It could lead to new treatments for people with Crohn’s disease,” she says.

Pharmacists can advise patients that the “best option for looking after your gut is to follow a healthy lifestyle, which luckily, is the same message for general health”, says Ms Thompson.

“It doesn’t need to include expensive products that are proposed to benefit ‘gut health’. These should be scrutinised for their evidence base and other more general health benefits.” 

References

1. Food Standards Agency (FSA) (2024). Cooking your food. https://www.food.gov.uk/safety-hygiene/cooking-your-food 

2. Guts UK. (2024) Healthy Eating. https://gutscharity.org.uk/advice-and-information/health-and-lifestyle/diet-2/

3. The Alliance for Education on Probiotics (AEProbio) (2025) Guide to Probiotic Products Available in the United Kingdom. https://probioticguide.uk/?utm_source=intro_pg&utm_medium=civ&utm_campaign=UK_CHART

4. NHS (2022) About Pepto-Bismol. https://www.nhs.uk/medicines/pepto-bismol/about-pepto-bismol/

5. Office for Health Improvement & Disparities. (2025) National Diet and Nutrition Survey 2019 to 2023: report. https://www.gov.uk/government/statistics/national-diet-and-nutrition-survey-2019-to-2023/national-diet-and-nutrition-survey-2019-to-2023-report