Pharmacy U

Digestive disorders and the pharmacist


The aches, pain, gurgles, bloating, and other issues associated with digestive upsets are compelling many Canadians to seek relief – as well as information – from their local pharmacist.


By donalee Moulton

Photography by Brandon Gray


“Patients often come to us for a differential diagnosis,” says Barbara De Angelis RPh, BScPhm, CGP, director, clinical pharmacy and quality at Rexall.

In many cases, the ailment is minor, and pharmacists, with their increasing scope of practice have the opportunity to help patients with effective products and educate them at the same time. If something more serious is suspected, a referral will be recommended. “Either way, we are often the first point of contact and patients come to rely on us for our expertise and support,” says De Angelis.

That reliance is reflected from behind the counter and in the frontshop. Over-the-counter medications are frequently available for digestive problems. Here’s where pharmacists can step out from behind the counter to answer patients’ questions and in the process strengthen relationships and build loyalty.

Helping patients means keeping abreast of what is happening in the field.

Pepcid and Zantac, for example, are widely known as former prescription medications now available over the counter. But new products are making the leap from prescription to front-store. The U.S. Food and Drug Administration has now approved the proton pump inhibitors Prevacid 24HR, Prilosec OTC, and Zegerid OTC for over-the-counter use to treat frequent heartburn for 14 days. It is anticipated approval will soon be granted in Canada.

“As more medications become over the counter, we have a greater role to play in assisting patients,” stresses De Angelis.

The demand for assistance is growing along with the increasing prevalence of digestive disorders. According to the Canadian Digestive Health Foundation, on average, five million Canadians alone experience heartburn and/or acid regurgitation at least once each week. Twenty-five per cent of pregnant women experience daily heartburn, and more than 50 per cent have occasional distress. Recent studies now show that GERD in infants and children is more common than previously thought.

While definitive data are not available on celiac disease, it is estimated to affect approximately one per cent of the population, and there is clear evidence that the incidence is growing, says Sue Newell, operations manager with the Canadian Celiac Association.

With that growth comes greater awareness of the disease and the concerns of patients. One of the newest developments, according to the Canadian Celiac Association, is the reluctance of pharmaceutical manufacturers to label their products as gluten-free.

Patients are often informed that while gluten isn’t added, the manufacturer can’t confirm whether or how much contamination might have occurred during processing. As a result, patients with celiac disease are uncertain what to do. “Because the product is a medication, and there are usually no alternative options, consumers become very fearful and may refuse to take needed medication,” says Newell.

Pharmacists can help put that fear into context, she notes. “Wheat starch is not a common ingredient in medication manufacturing. Corn and wheat are processed at different times of the year using significantly different equipment, reducing the farm-based contamination risk. When a manufacturer is dealing with milligram and microgram tolerances, manufacturing processes are not as loose as the messages imply.”

Understanding that digestive upset is a common side effect of many medications is also important, especially initially. “Reminding patients at the time of dispensing a drug with this potential side effect that they may have digestive symptoms can preempt a great deal of mental distress,” she adds.

It’s also important to ask patients where they are getting their information and point them in the direction of reliable sources, notes De Angelis. “It also helps to provide patients with a range of choices in the store and to carry a product mix of remedies that can help [relieve] a number of common digestive problems.”

Phramacists’ practical counselling is helping more and more Canadians stomach digestive disorders.