Giving digestive advice
Half of people say that they experience some kind of digestive discomfort. What's new in the category?
Digestive health complaints such as diarrhoea, constipation, indigestion and heartburn affect one in four Britons at least once a month, according to a poll released for this yearâ€™s Gut Week. Digestive disorders impact on quality of life and account for more than 10 per cent of GPsâ€™ workloads.
â€œChristmas is a key time of year for the digestive category in pharmacy as rich foods trigger heartburn and indigestion and when customers can really benefit from your advice,â€ says Anne Dawson, senior brand manager for Gaviscon.
Stress can influence digestive health. A survey carried out for Potterâ€™s Herbals found that 21per cent of people cited stress as a key trigger of digestive problems, including IBS, which a third believed was directly caused by stress.
â€œIBS sufferers are generally observed to have high levels of anxiety,â€ says Dr Chris Etheridge, medical herbalist at the Henry Potter Advisory Committee.
Market research company Mintel also identified stress as a common factor in increased incidence of GI health complaints. â€œCreating campaigns that promote stress reduction as a long-term treatment for GI health issues can help brands to position themselves as part of a broader approach to good health,â€ it says. Pharmacist Shaheen Bhatia from Careway pharmacy P&S Chemist in Ilford, London, says: â€œWeâ€™re seeing IBS becoming more common in younger people, even among teenagers who are stressed about exams.â€
Despite increased emphasis on the role of diet and nutrition in our health, almost half of adults who experienced GI symptoms in the past year said they didnâ€™t worry about the consequences of what they ate. â€œOur diet is changing and we eat a far wider variety of foods than ever before,â€ says Professor Julian Walters, consultant gastroenterologist at Imperial College and co-author (with health journalist Jo Waters) of Whatâ€™s Up With Your Gut?
â€œThere is also lots of generalised advice about healthy diet that doesnâ€™t suit everyone. For example, a high-fibre diet may be good for most of us, but if you have slow-transit constipation, where the gut doesnâ€™t move food at normal rate, more fibre will make it worse.â€
There are still taboos surrounding areas of GI health, and constipation is one of them. Research by Coloplast found that being unable to manage constipation effectively is leading to thousands of hospital admissions each year. During 2014â€“15, 66,287 people were admitted with constipation as the main condition, at a cost of Â£145 million. The research found embarrassment was a key factor, with one in five saying they wouldnâ€™t want to discuss it with their GP. The survey also highlighted a lack of understanding about constipation and how to treat it. â€œPharmacy staff can help by identifying customers who frequently buy OTC GI remedies, such as laxatives, antacids and PPIs, and finding out if theyâ€™ve had a proper diagnosis,â€ says Professor Walters. â€œThey should only be using these sorts of medicines for a few days a month.â€
Professor Walters stresses the importance of ensuring staff know the red-flag signs for serious GI health conditions: unexplained weight loss, passing blood in stools, change in bowel habit, difficulty swallowing, anaemia, abdominal pain or aged 55+ with weight loss and reflux, dyspepsia or upper abdominal pain.
GPs are missing vital red-flag signs for bowel cancer, suggests UK research. One in five cases diagnosed in A&E was found to have had early warning signs during the previous year. The study found that 18 per cent of bowel cancer patients and 23 per cent of rectal cancer patients had red flagsigns that could have prompted investigation earlier.
Make sure your staff are fully trained and updated on GI health and know when to refer to the pharmacist,â€ says Ms Bhatia. â€œCustomers will sometimes say they took something from their GP that helped but canâ€™t remember the name. We can now check their summary care record to see what was prescribed and offer an OTC version after a consultation. Weâ€™re lucky to have a minor ailment service in our area, which covers heartburn, so for those who qualify we can offer an antacid remedy.â€
â€œIncreasingly, we see customers with chronic digestive disorders such as IBS, Crohnâ€™s and coeliac disease,â€ says pharmacist Will Hughes from Alphega member Llanbedrog Pharmacy. â€œThese may require closer monitoring and support. Counter staff are the first point of contact for customers and have the opportunity to discuss digestive health. Running an awareness campaign is a great way to promote good digestive health and identify areas of concern. Ask customers â€˜Do you mind if I ask you a couple of questions about your digestive health?â€™ to start the conversation.â€
Professor Walters advises pharmacists to keep up-to-date with the latest medicines for digestive health problems. â€œBe aware of the repurposing of drugs for gut health problems,â€ he says. â€œFor example, amitriptyline for IBS pain as well as depression, colestyramine for bile acid diarrhoea as well as reducing cholesterol. Milk of Magnesia makes a good gentle laxative when taken in a small daily dose as it softens stools.â€ And make customers aware that a change in bowel habit can be caused by medication, such as NSAIDs and codeine.
Digestive health category
Sales of GI health remedies have increased in recent years and are now worth Â£228 million. This is thanks to growing consumer awareness, says Mintel. The category grew by 5.4 per cent last year and was largely driven by upset stomach, IBS and indigestion remedies. However, there is plenty of room for further growth as only 29 per cent of those whoâ€™ve experienced GI problems or made purchases will keep them to hand, with 44 per cent only purchasing when needed.â€œ
Lila Thakerar, pharmacist at Shaftesbury Pharmacy in Harrow, has this advice for the digestive category.
- Have dummy packs on show and plenty of information available for customers to help open up discussion. Encourage them to ask you questions and offer as much information as possible
- Have plenty of information available on new products and treatments
- Put up a notice to tell patients they can discuss digestive health in a private room
- When a rep comes in with a new product, set aside time for them to talk to staff as well
- Make customers aware that you have P products as well as GSL for digestive problems.
Ms Bhatia has this advice:
- Itâ€™s useful to run an in-store campaign every so often and get staff to discuss GI health. Link to other services that you offer that can help, too, such as weight management, smoking cessation, food allergy/intolerance tests.
- Up-skill staff and get each member to research one topic, for example constipation, diarrhoea, heartburn. Then get them to tell each other what theyâ€™ve learned.
Mr Hughes has this advice:
- When preparing a campaign, I discuss with my team how to approach customers in a sensitive manner. Looking for any cues that the customer is feeling uncomfortable is key and I encourage them to use the consultation room where appropriate. Dispensary staff are able to contribute to the campaign by identifying patients who regularly take NSAIDs and asking them if theyâ€™ve experienced problems.
- Another way to increase awareness of GI problems is to provide an allergy testing service that includes food intolerance testing. Offering these sorts of services helps to engage with customers and they can see that their local pharmacy offers much more than just a prescription service.
â€œYour shelf needs to be merchandised for selfselection by strength, format, flavour and price,â€ says Ms Dawson. â€œBrand name is one of the top decision-making factors, so merchandise brand leaders at eye level. And have an offering at the pharmacy counter to prompt purchases.â€
Points to remember
- Advise people know whatâ€™s normal for them in terms of their gastrointestinal system
- Help raise awareness with customers and patients that a change in diet can affect how the digestive system works
- Think about coeliac disease as a possible cause of digestive symptoms
- Be aware that a high-fibre diet isnâ€™t for everyone
- Advise people to not ignore any new or unusual symptoms
- Remind people that they should not be afraid to ask for advice or undertake investigative tests if necessary to rule out cancer
- Drinking milk may be healthy for many of us, but for those of African, Chinese or Mediterranean origin, a lactase deficiency means theyâ€™ll be unable to digest milk protein and it can cause GI problems, says Professor Walters.
Sara Baco, Avicenna Pharmacy, Braintree â€œWe see more queries for digestive health at this time of year, as people are more inclined overdo it with food and drink. People tend to come in asking about symptoms, rather than to request a specific product. They may be taking something already that hasnâ€™t helped, or their digestive symptoms are being caused by other medication. Gaviscon is our biggest seller, Nexium is also important for our pharmacy and weâ€™ve been giving IBS sufferers trial packs of the Alflorex supplement. We try to draw customersâ€™ attention to the help they can access through pharmacy, rather than have them visit their GP unnecessarily. Whenever weâ€™ve referred people to the GP thereâ€™s been a serious condition, so itâ€™s really important that do that.â€
Ali Hashemian, Avicenna Pharmacy, Swindon â€œReflux and indigestion definitely bring a lot of people into the pharmacy, with Gaviscon the most popular brand requested. We donâ€™t do too much to promote sales in this category. To be honest, I think itâ€™s better when patients donâ€™t just pick something up continually â€“ as the condition may need to be investigated by a doctor. There could be an underlying problem thatâ€™s causing people to experience these symptoms repeatedly. I think there should be a warning saying that people should only buy these products after speaking to a doctor or pharmacist. Other digestive complaints we get queries about are as constipation and diarrhoea, and IBS, which are usually dealt with by the doctor. We give out a lot of lifestyle advice to help people manage their digestive health.â€
Mithun Makwana, Avicenna Pharmacy, Bristol â€œThis is one of the most common condition areas that we see all year round and antacids, such as Gaviscon, go out a lot over the counter over the Christmas period. Weâ€™ve recently had a promotion on Enterosgel, which helps the normal gut flora and can help ease symptoms for people with IBS or IBD who are taking long-term omeprazole or PPIs. People usually donâ€™t know quite what product they should take and when they look at the digestive category shelf there is a lot of choice: Gaviscon, Rennie, Nexium and so on. Looking out for â€˜red flagâ€™ symptoms should be the top priority: dysphagia, unexplained weight loss and blood in the stools, which must be referred. Diet and lifestyle can have a big impact on digestive health and we always mention the impact of alcohol and smoking as well.â€
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