Tackling those GI blues

Although occasional heartburn elicited by over-indulgence is common, persistent heartburn and acid regurgitation are also the hallmark symptoms of gastro-oesophageal reflux disease (GORD). Other less common symptoms of GORD may include chest pain, hoarseness, cough, wheezing, asthma or dental erosions. GORD is usually a clinical diagnosis, although an endoscopy may be performed for confirmation. 

The aim of treatment is to manage symptoms and lower the likelihood of recurrence and complications. According to NICE treatment guidelines, patients with uninvestigated symptoms suggestive of GORD should be managed as though they have dyspepsia.² 

Proton pump inhibitors are the cornerstone of therapy for patients with an endoscopy-confirmed diagnosis of GORD and the initial treatment regimen lasts four to eight weeks.² If a patient fails to respond to first-line PPIs, then H2 receptor antagonists are an alternative option.² Long-term continuous usage of antacids is not recommended as a suitable treatment strategy for GORD.²

Key risk factors for developing GORD include a family history of the condition, older age, hiatus hernia and overweight/obesity. Stress, anxiety, smoking and alcohol consumption may also be additional contributory factors. Alongside pharmacotherapy, lifestyle measures can help in the management of GORD. Positive steps for sufferers include losing weight (if overweight or obese), eating healthily, avoiding heartburn trigger foods, stopping smoking, reducing alcohol consumption, and managing stress and anxiety. 

For any customer with suspected or diagnosed GORD, causative or exacerbatory medications should be reviewed. These are manifold and include anticholinergics, benzodiazepines, beta-blockers, bisphosphonates, calcium channel blockers, corticosteroids, NSAIDs, nitrates, theophyllines and tricyclic antidepressants.  

Constipation has a wide range of potential causes – the most common being insufficient fibre intake in the diet. Other factors can include not drinking enough liquid, lack of exercise or immobility, pregnancy and old age. Constipation is also one of the constellation of symptoms of IBS. 

In some cases, constipation can be medication related: potentially problematic drugs include codeine-containing painkillers, aluminum-based antacids, antispasmodics, antidepressants, diuretics, iron supplements and some anti-epileptic medication. Constipation can also occur as a rebound effect to long-term use of laxatives. 

The first step for managing constipation is lifestyle changes – notably an increase in fibre and fluid intake, alongside gentle exercise. 

Sufferers should be encouraged to drink plenty of liquid throughout the day and avoid holding back the urge to pass stools as this can exacerbate the problem. If lifestyle interventions fail to resolve the constipation, then numerous OTC treatment options are available – the most obvious being laxatives. 

Stimulant laxatives with active ingredients such as bisacodyl and senna work by stimulating nerve endings in the bowel to promote the movement of faeces. 

Bulk-forming laxatives like methylcellulose and ispaghula husk contain natural fibres that help increase faecal mass. This has the effect of boosting intestinal motility and also allows the stools to hold more water – making them softer and easier to pass. 

The final laxative type, osmotic laxatives, help to retain fluid in the bowel and the faeces. Lactulose is a key example. 

In addition to laxatives, stool softening agents (e.g. ducosate sodium) are also available to treat constipation. These work by softening and lubricating stools to make them easier to pass.

Diarrhoea can strike at any time and is most often a short-lived and self-limiting condition. It occurs due to inflammation in the large intestine, rendering it unable to absorb fluid as effectively and leading to increased liquidity of the ensuing stools. Sporadic episodes of diarrhoea can be caused by a flare-up of IBS or an underlying inflammatory bowel disease, or can occur due to stress/anxiety or certain types of food intolerances (e.g. diary products) 

Diarrhoea that lasts for several days or weeks is most often due to an acute viral or bacterial infection of the GI tract. These infections may be picked up during travel to foreign countries, particularly those with undrinkable tap water, or as a result of substandard food hygiene practices. It is also important to be aware of diarrhoea as a potential medication side-effect. Causative drugs include antibiotics (due to their bacteriocidal effects on gut microbiota), blood pressure medications and magnesium-containing antacids. 

Management advice for patients with diarrhoea should centre on avoiding dehydration. This is particularly important for the elderly and young children/babies where the condition can quickly become dangerous. Rehydration therapy for acute diarrhoea works to replace lost fluids and salts. 

Specific antidiarrhoeal medicines such as loperamide can also be recommended in cases where the swift resolution of diarrhoea is required (e.g. for work or special events). These work by slowing the transit time of food through the gut, allowing more water to be absorbed. 

OTC treatments containing bismuth sub-salicylate may be helpful for instances of bacterial diarrhoea because this salt directly targets the bacteria, as well as providing a protective coating over the stomach and intestines. 

If a diarrhoea sufferer has recently returned from foreign travel and is also experiencing high fever or other symptoms, they should be referred to their GP as treatment may be required for possible bacterial or parasitic infection.