GASTROINTESTINAL PROBLEMS
WITH THE HOLIDAY SEASON ALMOST UPON US, PHARMACIST CHANEL JONES EXPLAINS THE MOST COMMON DIGESTIVE PROBLEMS PEOPLE EXPERIENCE DURING THE HOLIDAYS, AND ENSURES THAT, AS A PHARMACIST, YOU ARE WELL PREPARED TO GIVE PATIENTS THE GIFT OF GOOD DIGESTIVE HEALTH THIS SEASON.
CAN YOU STOMACH THE HOLIDAYS? D
uring the holiday season, people are cruel to their stomachs. They overindulge on rich foods, puddings of every kind, ladle after ladle of gravy and one too many glasses of wine until their stomachs disagree. Ultimately, they pay big time for that overeating, which often leaves them with the ‘jingle bowels’, an upset tummy, and the subsequent need to guzzle a bottle of antacid. With GP surgeries and health centres closed during the holidays, community pharmacists should be in a position to offer help to patients experiencing uncomfortable gastrointestinal (GI) symptoms; including giving advice about lifestyle changes, using over-the-counter (OTC) medication, support with prescribed medication, and advice about when to consult a doctor.
The current value of the UK consumer healthcare market is £2.47 billion (year to July 2017), and there has been a 2.7 per cent increase in gastrointestinal OTC sales (Image 1).1 Over one third (38 per cent) of those who experience GI problems, or buy GI remedies, say they don’t always know which GI remedy to use for the problem they are experiencing.2
This year, you can help patients to break this tradition and enjoy the holiday foods without the nausea, heartburn, indigestion, upset stomach and diarrhoea or constipation. With several classes of indigestion treatments available, all working in different ways, it is important for both pharmacists and their staff to recognise and understand their suitability when recommending treatments or giving advice to customers.
COMMON GI COMPLAINTS The top three GI issues in the UK are: wind, bloating or flatulence (62 per cent), followed by indigestion (53 per cent) and diarrhoea (50 per cent).2 Indigestion, also called dyspepsia, is a common symptom caused by many conditions (often exacerbated by
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booze and rich food) and describes a feeling of pain or discomfort in the upper abdomen mainly caused when too much acid is produced which irritates the lining of the stomach. Signs of indigestion may be vague but can include belching, heartburn, bloating, and nausea. The terms heartburn and indigestion tend to be used interchangeably. Heartburn is felt when the valve or sphincter at the top of the stomach (which normally closes to keep the stomach contents from entering the oesophagus) doesn’t work properly and allows stomach acid and food to enter the oesophagus. The oesophagus does not have a protective lining and so the acid causes irritation, burning and can cause a bitter taste. This is also sometimes known as ‘acid reflux’. Some more serious conditions such as, angina, stomach and duodenal ulcers, and stomach cancer have similar symptoms; therefore, it is important to ask the right questions to ensure a more serious condition can be ruled out.
Bloating is an uncomfortable feeling of being ‘full’ after eating that can sometimes be associated with excessive wind. Often, treats such as dried fruit, sprouts and bread sauce are common culprits, but any food that contains yeast, sugar or alcohol can be a trigger as they’re harder to digest, causing excess acid to be produced and gas-producing fermentation in the gut.
Diarrhoea is a very common and Image 1
treatable condition that occurs when bowel contractions speed up, making the passing of stools more frequent, watery and loose. This means that the body is not reabsorbing water and salts at the normal level, causing water and salts to be absorbed into the bowel from the blood stream. The disturbing balance of salts or electrolytes leads to dehydration. Diarrhoea can either be acute or chronic; however, most of the time it resolves itself. Some common causes of acute diarrhoea are eating and drinking contaminated food or water, stress, food intolerances (such as milk) and some medication (such as antibiotics). Chronic diarrhoea tends to last longer than four weeks, and tend to be a symptom of more serious conditions such as inflammatory bowel diseases and Irritable Bowel Syndrome (IBS).
Constipation is defined as difficulty emptying the bowels or when there is a reduction in the frequency of someone’s normal bowel movements. People may also describe the sensation as ‘incomplete evacuation’. Constipation occurs due to the slower passage of faeces through the intestine allowing more water than normal to be absorbed from the intestine. As the faeces become harder and more compacted, their passage slows down further. During the holidays, constipation can be attributed to stodgy food, lack of fruit and vegetables and not drinking enough water.
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
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