Digestive Health

Digestive health encompasses a wide variety of medical conditions. In this blog post we will discuss the most common conditions affecting the digestive tract- their causes, symptoms, treatments and when to talk to you Doctor. As with all conditions your Pharmacist is freely available to talk to you about your symptoms and guide you to the most appropriate treatment.

A feeling of gastric discomfort, including fullness and distension, affecting the stomach and/or oesophagus (gullet).

Causes: high alcohol intake, eating large meals, eating very spicy foods, smoking, medicines, being over-weight, pregnancy, medical conditions- Gastro-oesophageal reflux disease (GORD), Gastritis, Duodenal ulcers, Gastric ulcers and irritable bowel disease. Unlikely causes would be gastric and oesophageal cancers or atypical angina.

Symptoms: Abdominal discomfort, bloating, flatulence, feeling full, nausea and vomiting and heartburn. Most symptoms will usually occurring shortly after eating or drinking.

Treatment: Diet and lifestyle changes- identifying triggers such as caffeine or certain foods and avoiding, stopping smoking, reducing alcohol consumption.

Antacids- work by neutralising stomach acid, they have a quick onset but effects only last a short while, always take after food. Caution they contain a high salt content and can bind other medicines- separate by 2 hours. Do not use for more than two weeks without speaking to your Doctor.

Alginates- form a raft at the top of the stomach- over the food we eat and prevent it from flowing back up the oesophagus causing heartburn. Usually fast acting and should be taken after meals and before bed.

Proton Pump Inhibitors (PPI’s)- block acid production by the stomach. Best taken in the morning one hour before food- take 2-4 days to take effect, they are a short term solution and should be discontinued once symptoms improve. Max 2 weeks for Esomeprazole and max 4 weeks for Omeprazole before seeing the Doctor. PPI’s can interact with other medications so always ask your Pharmacist before you take these medicines.

When to see your Doctor: Loss of weight, anorexia, recent onset of symptoms that are progressively getting worse, difficulty swallowing, blood in vomit or stools, severe pain that wakes you during the night, pain radiating to another area of the body such as the arm, shoulder or neck, using PPI medication for longer than recommended duration, age over 45 years and experiencing indigestion for the first time, vomiting, iron deficiency anaemia, if you are already taking multiple medications.

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An increase in frequency of soft stools relative to the patient’s normal bowel habits.

Causes: Viruses, Bacteria, medicine induced, irritable bowel syndrome, faecal impaction (resulting in watery stools), ulcerative colitis, Crohn’s disease, colorectal cancer.

Treatment: Oral rehydration salts, drinking liquids, keeping food simple, eating little and often, avoiding caffeine, alcohol, fatty and spicy food.

Loperamide- take two at onset of diarrhoea and then one after each loose bowel movement. Max 5 tablets in 24 hours. Over 12 years of age only.

Gelatin- suitable from 3 years and above- may help reduce symptoms of diarrhoea.

When to see your Doctor: Changes in bowel habits in those over 50 years, Diarrhoea following recent travel to tropical and subtropical regions, duration longer than 2-3 days especially in children and the elderly, unable to drink fluids, blood or mucus or fat in stools, suspected faecal impaction, severe abdominal pain.

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A reduction in normal bowel habits, with defection becoming more difficult and/or hard stools.

Causes: Change in environment (holidays), diet – lack of fibre, not drinking enough fluids, lack of exercise, medication, irritable bowel syndrome, advancing age, certain diseases (Parkinson’s, depression, hypothyroidism), pregnancy, rarely cancer.

Treatment: Diet and lifestyle changes- increasing movement, fibre and fluid intake.

Laxatives- Bulk-forming laxatives- good choice as they mimic fibre like our diet- they swell with come in contact with water and increase faecal mass reducing pain and making it easier to pass stools. Slow acting- can take up to 72 hours to work and must drink lots of water with them.

Osmotic laxatives- retain fluid in the bowel, helping to soften stools. Can take up to 48 hours to work.

Stimulant laxatives- tablets take 6-12 hours to work, so work quicker than the previous two options- usually taken at night and should be working by the following morning. Suppositories work even quicker- usually within 15-30 minutes. They increase motility in the bowel and are only recommended for short-term use.

When to see your Doctor: Severe pain on defecation, fever, over 40 years with sudden change to bowel habits, children with constipation, constipation for longer than 7 days with no cause, blood or mucus in the stool, unexplained weight loss, tiredness, if you are regularly using laxatives, if you are already on a lot of regular medication.

Haemorrhoids (piles) can often be associated with constipation- treatment with anaesthetics, astringents, anti-inflammatory creams and suppositories.

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A common condition (affecting up to 20% of people at some point in their lives) of the bowels with alteration of bowel habits- can include abdominal pain, cramping and bloating, sometimes diarrhoea or constipation or both, often associated with stress. There is no exact known cause of IBS- for some people it may have started after a particularly stressful time in their lives or after infection.

Treatment: Diet changes- identifying triggers and avoiding if possible, antispasmodics agents, if constipation or diarrhoea use treatment for such. Regular meals- do not leave long gaps, drink at least 8 cups of fluid per day (non-caffeinated), reduce processed starches.

Peppermint oil: Capsule formulation for adults and adolescents over 15 years. Should be taken on an empty stomach 30-60 minutes before food, relaxes the colon by reducing pressure.

Antispasmodics: Reduce cramping in the bowels, usually 12 years of age and above.

When to see your doctor: Blood in the stool, fever, nausea or vomiting, severe pain, children under 16 years, adults over 40 years with change bowel habits, fatty stools.

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Causes: Gastroenteritis, medications, radiation, cancer treatments, post-operative sedation, pregnancy, anxiety, food poisoning, motion sickness

Treatment: Ginger, acupressure wrist bands, referral to Pharmacist or Doctor for other treatment options, drink sips of clear liquid such as water, rehydration tablets or sachets, avoiding solid food until the episode has passed, eating small regular meals,

When to talk to your Doctor: severe abdominal pain, suspected pregnancy, unexplained nausea, vomiting in very young children or elderly with signs of dehydration.

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Probiotics are beneficial live bacteria found in some foods but also in supplements. Many foods contain probiotics such as yoghurt, kefir, kimchi, kombucha and pickled vegetables. Probiotic can also be taken as supplements- they come in many forms such as tablets, powders and liquids.

We all have bacteria in our digestive tract. The group of microorganisms that live in our gut is called the ‘microbiome’- these bacteria have many functions including helping protect us from infection, inflammation and may even reduce the risk of cancer. The food we eat plays an important role in feeding these bacteria. Foods that are high in sugars, fats and pesticides will destroy good bacteria. Antibiotic use can also kill off our good bacteria and causes changes to our gut microbiome.

A lot of research is ongoing into the use of Probiotics to help our microbiome. There has been some promising results with regard to preventing antibiotic-induced diarrhoea, constipation, infant colic and irritable bowel syndrome.

There are some people who should not take a probiotic or should check with their Doctor or Consultant team first such as those with small intestine bacterial overgrowth (SIBO) or those on immunosuppressant therapies or with severely compromised immune systems. Make sure to read ingredient labels carefully if you have an allergies or check with the Pharmacist

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