Community pharmacy can play a major role in helping people avoid as well as manage gastrointestinal problems. Dr Paul Vandewalle explains…

The structural gastrointestinal (GI) disorders are those in which there are abnormalities and include diverticular disease, colon cancer and inflammatory bowel disease (IBD).

However, the functional gastrointestinal disorders (FGIDs), for which no organic cause can be found, are the most common gut problems.

These disorders include irritable bowel syndrome (IBS), which has a significant impact on the individual’s health and wellbeing and on the burden of healthcare systems globally.

The gastrointestinal tract harbours a complex microbial community, the gut microbiome, which plays a pivotal role in human health. Disruption of the gut microbiota or dysbiosis can impact both pathological and functional gastrointestinal conditions such as IBD and IBS.

There are several factors that influence both the gut microbiome and gastrointestinal disorders:

• Diet
• Exercise
• Travelling or other changes in routine
• Stress
• Medications

Regular cancer screening for high-risk groups is essential. However, a healthy lifestyle can mitigate or prevent many gastrointestinal disorders. Providing healthy dietary advice (limiting added sugar and processed foods), exercise and reducing stress, would be a good place to start with improving digestive health.

Probiotics may alleviate the symptoms of diseases such as IBS and IBD. However, the research data, although convincing in animal studies, remains ambivalent in human studies without reasonable evidence to substantiate the benefits.

So what advice can pharmacists give their clients? An option is to simply suggest that they try a specific product to see whether this has any beneficial effects on their symptoms.

Prebiotics on the other hand result in changes in the composition and/or activity of the naturally occurring probiotics or beneficial bacteria in the gut. They are typically non-digestible and reach the colon where they are utilised by the beneficial bacteria. This helps to restore a healthy balance of bacteria in the gut and this may effectively alleviate symptoms of gastrointestinal disorders, with positive effects on the immune system.

The main source of prebiotics is dietary fibre which occurs naturally in fruits and vegetables. However, you would require large amounts of these foods to have any meaningful benefit on gastrointestinal health. Only 31% of men and 32% of women in the UK meet their daily requirement for dietary fibre.

It is also important to understand that not all commercial prebiotics are the same or have been extensively researched. In the manufacturing process different enzyme/substrate combinations will produce different prebiotic fibres and the enzyme determines the functionality of the prebiotic.

Bimuno, a unique galactooligosaccharide (GOS) mixture containing B-GOS, has been developed by Clasado using proprietary technology. The mixture is derived through the action of enzymes, from a probiotic bacterium, on the substrate lactose.

The evidence base supporting the science has transitioned from animal model studies and preclinical data to several human clinical trials and research is ongoing. Current research increasingly suggests that many aspects of health are linked to the diversity of gut microbiota.

Therefore, manipulation of gut microbiota to improve digestive health and overall wellbeing is a now a feasible option in mainstream medicine when other lifestyle options and dietary changes have been exhausted.

Dr Paul Vandewalle is principal scientific consultant at Clasado Research Services.

Gastroenteritis at a glance
• Gastroenteritis is a transient disorder due to enteric infection with viruses, bacteria, or protozoa.
• About 20% of the UK population develop gastroenteritis each year.
• The risk of complications (such as dehydration and electrolyte disturbance, haemolytic uraemic syndrome, and malnutrition) is greatest at the extremities of life, in people with concurrent chronic disease, and in those who are immunocompromised.
• Gastroenteritis is characterized by sudden onset of diarrhoea, with or without vomiting. Other symptoms include blood or mucus in stool, and fever or malaise.

Source: The National Institute for Health and Care Excellence

• Reckitt Benckiser retained a clear lead in digestive remedies in 2017 thanks to its leading positions in antacids and laxatives.

Source: Euromonitor