By Dragana Skokovic-Sunjic BSc (Pharm)
IBS or Irritable Bowel Syndrome (eye roll). Oh, boy. Here we go again. Aren’t we all tired of hearing about this elusive, difficult to define, impossible to treat, issue? How many times have we read about it? How many times has there been another new and miraculous cure for IBS, only to result in more disappointment?
As practising pharmacists, we talk with patients suffering from IBS every day. Or, more accurately, we try to talk with these patients, with varying success. Patients really do not want to talk about it; they have been down this road too many times, they have tried so many different things and here they are again. Nothing works. You can see it in their eyes: they are blaming themselves and think – it must be all in my head.
Canadian statistics tell us that 1 in 5 of us suffer from IBS. It is a problem that affects every aspect of a patient’s life, with far-reaching consequences. The problem is that all investigations and diagnostic tests will be normal, however, the patient is still suffering. Seventy per cent of IBS sufferers will have no symptom relief, and every second visit to the doctor will result in a change of therapy. Some patients will have bloating, discomfort, and bowel movements that are too frequent or missing. Blessed pain relief is usually achieved after passing stools. Then the cycle starts all over again.
We can all agree: this is not a life-threatening disease. We all have more important issues to deal with. Correct? How about we step into our patients’ shoes for one day only….
Imagine you are a female pharmacist, working a long shift. You just finished your sandwich during a 5-minute lunch break, there is a hospital discharge to be checked, and the physician next door is on hold (line 1), waiting to speak with you. Your technician is currently dealing with an irate costumer arguing about copayment for his prescription. It is no different than any other day. You can do this.
Only, you start feeling that sandwich, clawing its way around your gut. There are those warning signs that pain is not far away, and the urgency is coming next… .You decide to pick up the phone first and while listening to the physician on the other line, you feel like you should curl up on the floor and stay there until the discomfort passes. Your staff are getting impatient: you can see them exchanging exasperated looks. Eyes are rolling. No one understands what you are going through right now. And next thing you know, there is that urgency.…You will need to drop everything and head to the bathroom at the back of the store.
Similar situations are the reality for patients suffering from IBS. As much as we all like to joke about bowel movements, this is no laughing matter for people.
With so much information about IBS, prescription medications, OTC interventions, special diets, avoidance of FODMAPs, lifestyle interventions, meditations, stress reduction and their roles in alleviating IBS-related symptoms, what can we do? As pharmacists dealing with busy practices, we barely have enough time to add this topic to our CE portfolio. However, one of the interventions with mounting evidence is at our fingertips. We all have it on our shelves, our patients are reaching for this and using it, but often without proper guidance. We have all heard about “gut microbiota,” its effects on overall health, and especially, on gut health. At the same time an extraordinary amount of research has been conducted looking into using probiotic interventions for a variety of indications, especially in gut disorders such as IBS.
So, we have probiotic products on our shelves. Patients are already using them. What more can we do about it?
Let’s get really specific about strain specificity! Not every probiotic will be effective for all symptoms. It is extremely important to match specific probiotic strains to desired outcomes as observed in clinical trials. We can make crucial differences by providing precision recommendations. We can advise our IBS patients which probiotic product to use, and we can do that with confidence. There are great resources available (see additional resources) to help give your patients guidance.
I am speaking from experience: in my practice it can be something as simple as recommending the appropriate probiotic product for my patients’ IBS symptoms to completely transform their quality of life.
It can be as simple as that!
Dragana Skokovic-Sunjic, BSc (Pharm)
Dragana Skokovic-Sunjic is a clinical pharmacist with Hamilton Family Health Team and a NAMS Certified Menopause Practitioner. She is also a leader in knowledge mobilization for probiotics in Canada and the United States