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Gut reactions

In April 2018, NHS England issued new prescribing guidance for CCGs covering common self-limiting conditions, including indigestion and heartburn, diarrhoea in adults and infrequent constipation, encouraging more self care.

Digestive health is one of the most well-established over-the-counter (OTC) categories in pharmacy, offering a wide variety of products for various acute and chronic conditions. As we approach thefestive season of overindulgence, which often aggravates existing digestive ailments (or triggers new symptoms), pharmacies may become the first port of call for self-management products and advice.

Many digestive remedies have been available for decades, so product and marketing innovation are essential to offer something different and keep the category ‘fresh’. But the market is also changing. According to a Euromonitor report, Digestive Remedies in the UK, published in November 2017, consumers are taking a more holistic approach to health with an increasing emphasis on prevention and turning towards products with a more natural positioning. 

“The growing trend for interest in establishing and maintaining good gut health continues to grow exponentially with the public,” says Precision Biotic’s marketing manager Antonia Bird. “For the Christmas/New Year period, gut-related concerns reach a crescendo, often as a result of overeating, or even stress. We also know this heralds the start of the January and New Year New You campaigns, where many vow to take control of their own health. We plan to tap into these trigger opportunities with public relations, social media, advertising (both in print and online) as well as influencer activations.”

Changing needs

Amy Wakelam, Brand Lead for Rennie, says that pharmacies should offer a range of product formats and dual purchase opportunities, so that they are best placed to meet customer needs. Rennie, the market leader in heartburn and indigestion tablets, is a beacon brand for the category and plays an important role in bringing in new users. This year, the brand is extending the brand’s repertoire and driving category growth with the launch of new Rennie Liquid Heartburn Relief oral suspension.

“Liquid products are ideal for the relief of heartburn and indigestion symptoms at home whilst tablets provide the convenience of on-the-go symptom relief,” says Amy Wakelam. “Format and brand have the greatest influence on sufferers making a decision about the right treatment for them, followed by pack size, flavour and then price. Fifty-nine percent of new OTC shoppers select Rennie as one of their brands, while 30 per cent use it as their main brand. Positioning the category prominently over the festive season, merchandising by brand and using educational point-of-sale material to inform shoppers about product benefits will all help to drive sales at this key time of year for the category.”

The Medicines and Healthcare products Regulatory Agency (MHRA) recently announced that it is considering imposing stricter regulations on the sale of laxatives amid concerns they could be abused by people with eating disorders. Rebecca Field, head of communications at the eating disorders charity Beat, says that laxatives pose severe health risks for people with eating disorders and patient safety should be an absolute priority. The MHRA’s UK-wide review will take several months, but this could lead to changes in the self-management of mild constipation, prompting patients to find new solutions.

Relaxit microenema (Supra Enterprises) is a class one medical device for softening hard stools in people with constipation, providing in innovative way to manage constipation at home. From January 2019, the company will be promoting the product to healthcare professionals and consumers, removing the stigma associated with using enema products.

“None of the ingredients in Relaxit are systemically absorbed and the product is used almost directly at the side of action so it’s fast-acting,” says Vijay Ruparelia, product development executive and pharmacist at Supra. “But we need to educate patients on how to insert microenema products as this isn’t something most people are used to. Most people are more used to taking an oral tablet. Relaxit has many benefits that pharmacists can promote easily. The product can be used by all ages, from one month onwards, and also during pregnancy. It is also suitable for older people who may have swallowing difficulties or are using other medication that may interact with conventional laxatives.”

Natural approaches

According to the November 2017 Euromonitor report, the shift towards smaller players in the digestive remedies category in 2017 was influenced in part by demand for more holistic management approaches. Not only does this cover natural treatments, but also preventative measures to keep the digestive system in good health.

Natasha Terinova, marketing director of Enteromed, distributors of Enterosgel intestinal adsorbent for diarrhoea, says the brand is highlighting the science backing the product and supports moving opioid medicines away from OTC sales. “We’re creating campaigns that capitalise on the fact that Enterosgel is an effective self-treatment,” she says. “Enterosgel is a drug-free safe treatment without systemic side effects suitable for all even for neonates and pregnant women. Patients with IBS end up taking opioids for years, often becoming addicted.”

Probiotics are a popular supplement for digestive health and the focus of ongoing medical research. Recent research studies, by Israeli scientists, suggest that not all probiotics will work for everyone as the bacterial components of the gut microbiome vary from person to person. The research also found that probiotics may stop the gut’s microbiome from returning to normal after a course of antibiotics. However, these were very small studies and didn’t look at the clinical effects of probiotics, so more research is needed.

Dr Colin Hayward, medical director at Symprove says: “The study in Cell investigated a probiotic formula developed by the investigators for the purpose of the study. It clearly highlights the need for probiotics that are well formulated and show delivery of bacteria to the gut as well as an impact on the bacteria that already live within the microbiome. It’s an exciting field but clearly development pathways and defined regulatory standards are needed. Products like Symprove, that not only survive stomach acid, but go on to thrive in the intestine could support the gut microbiome. The challenge for any oral product is to show an impact under controlled rigorous studies – this is why at Symprove we continue to invest in research.” 

Brands such as ADM Protexin and Symprove, highlight the research behind their products and the nutritional importance of probiotic products. “Our team of nutritional advisors are available to help with window displays and in-store days to help increase footfall into their pharmacy,” says Hayley Milne, brand manager at ADM Protexin Ltd. “They are even on hand to provide training on gut health and our products for any store member and team that would like to learn more. In addition, our in house technical team are always on hand to chat through our products or latest research with any team member that wants to delve deeper.”

At Symprove, Colin Hayward says: “Extreme changes in dietary habits over festive periods are something I’m sure we can all relate to – from an increased consumption of rich foods to eating out of sync at late night parties coupled with alcohol, and we see exacerbations, or relapses, in conditions such as IBS [irritable bowel syndrome].  Pharmacists should be aware of the importance of the microbiome on gut health and how a balanced and ‘fed’ microbiome can benefit their patients. We know that products like Symprove, which has been shown to reach the gut and feed the microbiome in the intestine, can have a positive effect for people.”

According to Melanie Bulger, nutrition and regulatory manager at Bimuno, pharmacists should also draw attention to prebiotics. “Prebiotics are fertiliser for the gut and grow own good bacteria whereas probiotics can be more complicated, as demonstrated by the recent studies,” she says. Different probiotics can have different effects so it would be difficult for a busy pharmacist to identify which strains/products are idea for each customer. Bimuno is demonstrated to reach the gut, unlike some probiotics, and will grow the good bacteria that you already have rather than consuming a strain of bacteria you may not necessarily need.”

Thorrun Govind

Locum pharmacist, Bolton

Sarina Mughal

Day Lewis Pharmacy, Knightsbridge

Mital Thakrar

Well Pharmacy, Birmingham

“There is still some embarrassment surrounding digestive health problems, so we offer customers use of the private consultation area for discussion. We get a lot of queries about IBS symptoms, and if customers have been prescribed PPIs then they might ask us whether it’d also be useful to take probiotics. Popular brands for us include Buscopan and Gaviscon. Bowel Cancer Awareness month in April is a good opportunity to start conversations with customers about bowel health.”

“This is an extremely important category for us all year round. Gaviscon is our best seller. We find that many as of our patients prefer the Gaviscon double action liquid sachets as they are very practical. Other best sellers for us are Windeze and Buscopan. Recent trends include probiotics and supplements containing super foods, so we stock brands such as Biocare, NaturesPlus and Wild Nutrition supplements. It is vital that if you stock a variety of vitamins/supplements you have options that contain organic ingredients, lactose free or even vegan options.”

“Mostly we are asked about reflux and acid. This category is very important for us. Having a good knowledge of the different treatments available means we can offer the customer different ways to tackle the issues. Explaining in easy to understand language how each drug works and what it will do to the body will help the customer take control of their own condition. Supporting lifestyle advice can really help. There are many opportunities to grow the category through offering customers choice, advice and intervention support.”

 




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