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Digesting the opportunities

Clinical

Digesting the opportunities

Digestive health is a rewarding category for independents, with an armoury of products that mean they can offer instant relief for patients. Kathy Oxtoby reports…

Pharmacists can support patients to maintain good digestive health by giving healthy lifestyle advice, says Julie Thompson, information manager for the charity Guts UK.

This includes highlighting the importance of a balanced diet with 30g of fibre a day from different sources such as fruit, vegetables and whole grains.

For bowel health, people are advised to limit their red meat consumption to 70g per day and have meat free days. They should avoid excessive alcohol consumption and quit smoking. Regular exercise is also good for preventing constipation, she says.

Irritable bowel syndrome

IBS is a common digestive disorder. Its main symptoms are abdominal pain, bloating, and changing bowel habits, such as diarrhoea, constipation, or both, says Ms Thompson.

The exact cause of IBS is unknown, but it is believed to be multifactorial, involving gut-brain axis dysregulation, gut motility issues, visceral hypersensitivity, and possibly small intestinal bacterial overgrowth (SIBO).

It is triggered by stress, certain foods, hormonal changes, and infections, says Jacquie Lee, medication safety officer and information pharmacist at Numark.

Pharmacy teams can recommend OTC medications to treat IBS. These include: antispasmodics, for example, hyoscine butylbromide to relieve cramping, laxatives such as lactulose for constipation, anti-diarrhoeals like loperamide for diarrhoea, probiotics to support gut health, and peppermint oil to help reduce symptoms such as bloating and pain, says Ms Lee.

“For IBS, self-help advice can include eating small, regular meals every four to five hours and trying not to skip meals. It may also help to avoid large meals and rich/fatty foods late at night,” she 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 Ms Lee.

Popular brands for IBS include Colofac IBS, and Buscopan for colic pain, says Lila Thakerar, superintendent pharmacist at Shaftesbury Pharmacy in Harrow. For constipation she recommends Senokot as a gentler laxative, and for something more immediate, Dulcolax, which comes in oral and suppository formulations.

For diarrhoea she recommends Imodium, and an electrolyte supplement for dehydration.

Irritable bowel disease

Irritable bowel disease (IBD) can present with abdominal pain, cramping, and changes in bowel habits (diarrhoea and/or constipation). 

IBD is an immune system dysfunction, with an abnormal immune response attacking the digestive tract. Genetic factors increase the risk of having the condition, alongside environmental factors such as smoking, diet, and possible infections, says Ms Lee.

For IBD there are a number of medications available: anti-inflammatory drugs, for example mesalazine, immunosuppressants such as azathioprine, biologicals, for example infliximab, and corticosteroids for acute flare-ups.

Specific diets and nutritional supplements can help relieve symptoms and frequent check-ups are advised to monitor disease progression and complications, says Ms Lee.

Heartburn and acid reflux

Heartburn and acid reflux is common. Symptoms include heartburn pain behind the sternum, a burning feeling that reaches up to the throat, a sour taste in the mouth caused by stomach acid, pain when swallowing, throat clearing, and coughing.

Symptoms are often worse after eating, or lying down. If symptoms persist, a referral to the patient's GP should be made, says Ms Thompson.

Excess body weight, smoking, drinking alcohol to excess, stress and anxiety, a hiatus hernia, and a stomach ulcer, can all give people symptoms, she says.

Patients can take antacids which usually work immediately and are best taken after meals and before going to bed, says Ms Thompson. 

They can also take alginates - products that form a protective layer on the stomach and help prevent reflux, which can be taken after meals and before going to bed to reduce nighttime symptoms. Some products are a combination of alginates and antacids, she says. 

Acid suppressing medications include proton pump inhibitors (PPIs), which are best taken prior to breakfast or an evening meal, she says.

Constipation

Constipation is a digestive disorder which has a number of different causes, including low fibre and fluid intake. It can be caused by some medications and a low level of activity, says Ms Thompson. 

Regular activity, a good level of dietary fibre, and adequate fluid intake – six to eight glasses a day - can help to manage constipation, she says.

Laxative treatments can also be considered. If the constipation is not resolved after a month to six weeks, patients should be referred to their GP, she says.

Over and under-nutrition

Problems can arise from over and under-nutrition. Over-nutrition, a “higher than healthy body weight”, can affect the digestive system, says Ms Thompson. Pharmacists can signpost customers to weight management services. “Even losing 10% of excess weight can have health benefits.” 

With under-nutrition, where people have a lower than healthy body weight, and particularly where there has been unintended weight loss along with digestive symptoms, this could be a red flag for digestive cancers, and patients should be advised to see a doctor, says Ms Thompson.

Latest research into digestive disorders 

To help support patients with digestive disorders it is important for pharmacists to keep up-to-speed with the latest developments in this area. 

For example, a new capsule sponge test is available in some parts of the UK to identify Barrett’s oesophagus - a potentially pre-cancerous condition - in people who have persistent heartburn and reflux symptoms. 

Research funded by Guts UK is being carried out into the development of a breath test to pick up oesophageal cancer in the early stages, when it is more likely to be cured. 

And around the world, research is taking place into the genetic causes of digestive conditions, says Ms Thakerar. 

Helping patients with digestive disorders

To help patients with digestive disorders who come to the pharmacy with prescriptions for gastrointestinal issues, Ms Thakerar advises them on diet and lifestyle. “All this is assessed depending on the underlying condition.” 

“We make every contact count,” she says. It is important to “grab opportunities to give people advice and to promote products”.

"Refer to a GP when you notice any red-flag symptoms including blood in stools, unintentional weight loss, anaemia, and persistent pain not relieved by OTC medications,” says Ms Lee.

“The same applies if symptoms persist despite following dietary and medication advice. Severe or worsening symptoms that do not respond to initial treatments are also a sign that the patient needs to be referred.” 

New symptoms in patients over 50 should be evaluated to rule out other serious conditions, she says.

“Be aware of all the new products being marketed,” advises Ms Thakerar. “It’s a competitive market out there, with brand leaders continually producing new products. Pharmacists and teams need to be aware of all the options available to give patients choices.”

Digestive health is “a large category for pharmacists”, she says, “and it’s an opportunity to use our skills to offer a service to patients, so they don’t have to see their GP.”

Resources

·     British Dietetic Association (BDA): Irritable bowel syndrome (IBS) and diet. https://www.bda.uk.com/resource/irritable-bowel-syndrome-diet.html

·     Crohn’s & Colitis UK: https://crohnsandcolitis.org.uk/ 

·     Guts UK: https://gutscharity.org.uk/ 

·     The IBS Network: https://www.theibsnetwork.org/

·     NHS: Irritable bowel syndrome. https://www.nhs.uk/conditions/irritable-bowel-syndrome-ibs/ 

·     NHS: Ulcerative colitis. https://www.nhs.uk/conditions/ulcerative-colitis/         

·     NHS: Crohn’s disease. https://www.nhs.uk/conditions/crohns-disease/ 

·     NHS: The Eatwell Guide: https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/the-eatwell-guide/

·     What’s up with my gut?: https://www.whatsupwithmygut.org.uk/

 

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