DIGESTION


available over the counter. They work by reducing the amount of acid produced in the stomach by stopping histamine from being able to bind to h2 receptors in the stomach. They're good drugs for occasional heartburn, although they're most effective when taken an hour before eating,


Image 2: Sales value of OTC medicines for gastrointestinal treatments in Great Britain in 2014 (in millions GBP)


> Patients should always contact their gP or seek emergency medical attention if their symptoms are accompanied by the following:


• debilitating or unusually severe pain anywhere in the abdomen


• knife-like or severe cramping pain • prolonged vomiting • fever • severe diarrhoea • blood in the stool or vomit, or black and tarry stools


Prevention One of the most important pieces of advice a pharmacist could give patients would be to tell them to chew every bite thoroughly, eat smaller portions and say ‘no’ to seconds. Patients should also be encouraged to drink plenty of water and increase the amount of fruit and raw vegetables every day. They should also avoiding eating late at night. Sitting for at least 30 minutes after meals can also help to aid their digestion.


Patients, who have IBS, should also keep a food diary and record which foods make them feel uncomfortable. The Christmas period can be a great time to introduce probiotics as a defence to digestive problems including bloating, constipation and gastroenteritis.


Patients who experience heartburn could try sleeping with an extra pillow to help reduce the backflow of acid. To avoid serious conditions like food poisoning, patients should be advised not eat leftovers after more than 48 hours and should not leave food outside a fridge for over an hour.


OTC treatment Indigestion remedies are the most commonly bought gI remedies (Image 2)3


. They include: antacids,


alginates, h2-receptor antagonists and a proton pump inhibitor (PPI). Antacids would include ingredients such as aluminium and magnesium hydroxide, calcium and magnesium carbonate and sodium bicarbonate.


They are all alkaline salts which neutralise the excess acid in the stomach, breaking it down into water and other natural substances.


Antacids tend to be a popular choice as they start working almost immediately. however, magnesium- containing products tend to cause diarrhoea and aluminium-containing products tend to cause constipation. Extra caution should be taken in patients with hypertension and other heart conditions as sodium- containing products can cause an increase in blood pressure. In addition to where they are situated within the gIs ection in your pharmacy, small packs of antacids could be placed in high-visibility areas - such as near the counter or till - to drive impulse purchase.


Alginates, such as sodium alginate, form a raft on the surface of the stomach contents which reduces acid reflux, protecting the oesophagus. Due to the way alginates work, they should be taken after meals and before bed.


h2-receptor blockers would include the drugs ranitidine and famotidine. These drugs were originally prescription medicines but are now


After undergoing a POm to P switch in recent years, PPIs work by reducing the amount of stomach acid produced through blocking the action of the proton pump. The advantage of taking a PPI is that patients can have relief of their symptoms for a few weeks; however, they won’t relieve heartburn right away, as they may take up to one or two hours to work. They are best taken on an empty stomach at least 30 minutes before food. Examples of PPIs available OTC are omeprazole, esomeprazole and pantoprazole.


Anti-diarrhoea medicines such as loperamide help relieve diarrhoea by slowing down the bowel contractions which allows more time for the water and salts to be absorbed normally into the body. while effective, these medicines can sometimes result in a new problem: constipation. loperamide should not be used where there are any signs of an infection, as it could trap the bacteria in the gut make the infection worse.


Constipation can be treated with: • bulk-forming laxatives (eg, ispaghula husk), which add bulk to the stools and soften them


• osmotic laxatives (eg, lactulose), which draw water into the bowel, making stools softer and easier to pass


• stimulant laxatives (eg, senna, bisacodyl and sodium picosulfate) which work by stimulating the nerve endings in the bowel to


move the faeces on


• faecal softeners (eg, docusate sodium and glycerine suppositories) which work by lubricating the faeces. glycerine suppositories also have a stimulant action on the bowel.


Other products available are deflatulents and antispasmodics. Deflatulents such as silicone, dimeticone and simeticone work by dispersing excess gas (caused by too much acid production) from the stomach. Antispasmodics such as peppermint oil, mebeverine and hyoscine are available as OTC medicines to help with mild stomach cramping and spasming by relaxing the smooth muscle in the bowel walls.


Natural remedies for treating gI upsets would be drinking the likes of peppermint or ginger tea to relieve indigestion and nausea. herbs such as artichoke and dandelion are particularly supportive for the liver, which has prime responsibility for metabolising fats and can struggle with the extra challenges loaded onto it during the festive season.


References 1. PAgB: understand the consumer healthcare market [Internet]. PAgB. [cited 2017 Oct 16]. Available from: https://www.pagb.co.uk/about- us/about-our-industry/ 2. Eighty-six per cent of Brits have suffered from a gastrointestinal problem in the past year | mintel.com [Internet]. [cited 2017 Oct 16]. Available from: http://www.mintel.com/press- centre/beauty-and-personal-care/86-of-brits-ha ve-suffered-from-a-gastrointestinal-problem-in- the-past-year 3. OTC market breakdown: gastro-intestinal treatment medicine sales | Uk [Internet]. Statista. [cited 2017 Oct 16]. Available from: https://www.statista.com/statistics/417545/over -the-counter-sales-for-gastro-intestinal- treatments-in-great-britain/


RENNIE hEARTBURN, INDIgESTION AND wIND RElIEf


Rennie heartburn, Indigestion & wind Relief is a triple combination tablet which tackles three of the most common digestive health ailments. The chewable, mint flavoured tablet gives fast and effective relief day or night. Rennie heartburn contains antacids calcium and magnesium carbonate offering a rapid and powerful neutralising action which turns excess stomach acid into water. whilst simethicone, an anti-foaming agent, causes gas bubbles to join and gently disperse the trapped gas easing any trapped wind. The formulation acts physically rather than by entering the bloodstream and can be taken during pregnancy or whilst breastfeeding. for stock enquiries contact Ceuta healthcare on 0844 243 6661. RRP £2.49 (12s) and £4.25 (24s). Visit the Rennie website (rennie.co.uk) for more information.


PhARmACy IN fOCUS - 17


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