Patients May Find Nonprescription Options for GI Symptoms Overwhelming

Pharmacy TimesOctober 2021
Volume 87
Issue 10
Pages: 32

But pharmacists can offer guidance on self-treatment vs more serious issues requiring evaluation.

The significance of overall digestive health is often underestimated until an issue arises. The digestive system includes the gallbladder, gastrointestinal (GI) tract, liver, and pancreas.1 Digestion is important for breaking down food into nutrients, which the body uses for cell repair, energy, and growth.1 Research results have clearly established the relationship between gut microbiota and human diseases, which has been a major topic of interest for many studies, and ever-increasing evidence has suggested that disturbances in the gut microbiota play an important role in the development of and exacerbation of certain diseases, affecting the immune system and overall health.2 Other research results have indicated that the gut microbiome has a major role in the digestion of food and in the central nervous and immune systems, as well as other physiological processes.3

Everyone experiences digestive issues from time to time, and many mild to moderate GI issues are amenable to self-treatment. However, some individuals frequently experience uncomfortable GI issues, such as acid reflux, bloating, constipation, and indigestion, which can negatively affect productivity and quality of life. It is critical that patients experiencing severe GI symptoms, or whose symptoms are not improving or worsening despite self-treatment, seek immediate medical care.

An estimated one-third of the world’s population has some form
of digestive symptoms, most commonly bloating and constipation, according to the World Gastroenterology Organisation.4 Additionally, there is a considerable percentage of Americans who regularly experience GI symptoms but do not seek care from clinicians.5 Less than 20% of individuals with abdominal pain, bloating, or diarrhea consult health care providers for evaluation and management of their symptoms.5 Examples of some of the most common GI complaints include dyspepsia and heartburn, with an estimated 60 million individuals in the United States experiencing heartburn at least once a month and more than 15 million experiencing heartburn daily.6

The pharmacy shelves are lined with products marketed for digestive health and the treatment of common GI ailments, and the selection of these products may be overwhelming for many patients, especially individuals with other medical conditions and/or who take other medications.

Pharmacists are well positioned to help patients select the appropriate nonprescription products and encourage individuals with chronic and/or recurring GI symptoms to seek further medical evaluation and treatment. Some of the most common nonprescription GI products to treat and prevent mild to moderate GI issues” to promote digestive health include antacids, antidiarrheals, fiber supplements, H2 blockers, proton pump inhibitors, prebiotic supplements, and probiotics. Individuals with mild to moderate GI issues, such as constipation, flatulence, heartburn, and indigestion, may opt to self-treat these ailments with the appropriate agents.


Results from a recent global survey involving 16 countries regarding probiotic use showed that, globally, an estimated 47% of survey participants were familiar with probiotics, which increased from 42%, as reported in the 2019 survey.7 They also noted that the reasons for taking probiotics were to promote bone, digestive, immune, and joint health.7

Results from another study from the journal Gut showed the benefits of psyllium in the reduction of inulin-induced colonic gas in patients with Rome IV criteria irritable bowel syndrome.8

Study results published in Gut showed that association between gut microbiota composition, levels of cytokines, and inflammatory markers in patients with COVID-19 suggest the gut microbiome is involved in the magnitude of COVID-19 severity, possibly via modulating host immune responses. However, more research is warranted.9

Research results published in the journal Gastroenterology indicated that vitamin D has been implicated in the pathogenesis of colorectal cancer (CRC), but it remains unknown whether total vitamin D intake is correlated with early-onset CRC and precursors diagnosed before 50 years of age. The authors concluded that in a cohort of younger women, higher total vitamin D intake was correlated with a decreased risk of early-onset CRC and precursors. However, more research is warranted.10


Pharmacists can be instrumental in identifying patients at risk for or exhibiting signs and symptoms associated with GI conditions that warrant further medical evaluation and treatment. They can also encourage patients to be proactive about their digestive health and discuss their risk of GI conditions with their primary health care providers. Because colon cancer is on the rise, especially among younger patients, and the COVID-19 pandemic decelerated colon cancer screenings, it is imperative that pharmacists seize every opportunity to encourage patients to discuss colon cancer awareness and prevention with their primary health care providers. In October 2020, the US Preventive Services Task Force recommended beginning CRC screening at 45 years of age, aligning its guidelines with those of the American Cancer Society.11 The American College of Gastroenterology also changed its guidelines in March 2021.12

As the gatekeepers of ensuring and promoting the proper and safe use of both nonprescription and prescription medications, pharmacists should provide patients with guidance on the correct use of products marketed for digestive health and those available for the prevention and treatment of mild to moderate GI ailments amenable to self-treatment.

During counseling, pharmacists can also remind patients of nonpharmacological measures that can be used for digestive health, such as eating a balanced diet, exercising, hydrating, maintaining a healthy weight, obtaining the recommended daily fiber intake, quitting smoking, and reducing stress.

The American College of Gastroenterology provides an excellent resource for patients about digestive health on its website.

Yvette C. Terrie, BSPharm, RPh, is a consulting pharmacist and a medical writer in Haymarket, Virginia.


Digestive diseases. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed September 23, 2021.

  1. Kho ZY, Lal SK. The human gut microbiome - a potential controller of wellness and disease. Front Microbiol. 2018;9:1835. doi:10.3389/fmicb.2018.01835
  2. Moayyedi P, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG clinical guideline: management of dyspepsia. Am J Gastroenterol. 2017;112(7):988-1013. doi:10.1038/ajg.2017.154
  3. Robertson R. Why the gut microbiome is crucial for your health. Healthline. June 27, 2017. Accessed September 8, 2021.
  4. Digestive health resources. World Gastroenterology Organisation. Accessed September 23, 2021.
  5. Almario CV, Ballal ML, Chey WD, Nordstrom C, Khanna D, Spiegel BMR. Burden of gastrointestinal symptoms in the United States: results of a nationally representative survey of over 71,000 Americans. Am J Gastroenterol. 2018;113(11):1701-1710. doi:10.1038/s41395-018-0256-8
  6. Masterson D. Survey: 1 in 4 global consumers used probiotics in the last 6 months. NutraIngredients. Updated August 12, 2021. Accessed September 9. 2021.
  7. Gunn D, Abbas Z, Harris HC, et al. Psyllium reduces inulin-induced colonic gas production in IBS: MRI and in vitro fermentation studies. Gut. 2021;gutjnl-2021-324784. doi:10.1136/gutjnl-2021-324784
  8. Yeoh YK, Zuo T, Lui GC-Y, et al. Gut microbiota composition reflects disease severity and dysfunctional immune responses in patients with COVID-19. Gut. 2021;70(4):698-706. doi:10.1136/gutjnl-2020-323020
  9. Kim H, Lipsyc-Sharf M, Zong X, et al. Total vitamin D intake and risks of early-onset colorectal cancer and precursors. Gastroenterology. 2021;161(4):1208-1217.e9. doi:10.1053/j.gastro.2021.07.002
  10. Bankhead C. USPSTF: start CRC screening at age 45. MedPage Today. October 27, 2020. Accessed September 10, 2021.
  11. Shaukat A, Kahi CJ, Burke CA, Rabeneck L, Sauer BG, Rex DK. ACG clinical guidelines: colorectal cancer screening 2021. Am J Gastroenterol. 2021;116(3):458-479. doi:10.14309/ajg.0000000000001122
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