10 months ago

2017 HCHB_digital

Irritable Bowel Syndrome

Irritable Bowel Syndrome Irritable bowel syndrome (IBS) is a common gastrointestinal disorder with a worldwide prevalence of 10%–20%. Symptoms can range from minor and occasional to severe and disabling. Because the symptoms of IBS are similar to the symptoms of many other conditions, it often takes years to exclude other conditions and to diagnose a person’s symptoms as IBS. IBS is more common in women than in men and occurs more often in people in the 20 to 40-year-old age group. IBS can occur in children and many people can trace the onset of their symptoms back to childhood. Onset in old age is rare. The exact cause of IBS is not known but experts suggest it may stem from a problem with nerves that control the bowel. Symptoms of IBS The difficulty with diagnosing IBS is that symptoms can vary, although alternating diarrhoea and constipation is considered a key symptom for diagnosis. Sufferers typically describe three to four days of constipation followed by one to two days of loose bowel motions. Other symptoms typical of IBS include: • abdominal bloating – may more commonly occur in the evening, and may be accompanied by increased gurgling and rumbling. Clothing may become uncomfortable • cramping, often just prior to a bowel movement; also increased flatulence • mucus in the stools • sensation of incomplete evacuation of the bowel or an urgent need to evacuate the bowel • tiredness. IBS may also cause lower back pain and has been associated with painful periods, pain with sexual intercourse, fibromyalgia, and bladder symptoms. IBS triggers Certain things can trigger IBS symptoms, including: • change of routine • food intolerance »» Lactose is the most common dietary trigger for IBS. Fructose and sorbitol may also trigger IBS. »» Alcohol, caffeine, carbonated drinks, dairy products, fried or fatty foods, low-fibre diets and preserved foods have also been implicated. • hormones »» Some women are prone to IBS symptoms around the time of their period, although endometriosis should be excluded as the cause. • infection or food poisoning »» Bowel symptoms may persist long after the offending bacteria or virus has been eliminated. Estimated to be responsible for up to 25% of IBS cases. • smoking • some medicines (eg, antibiotics, antacids, painkillers) • stress, depression or anxiety. TREATMENT OPTIONS Category Examples Comments Antispasmodics Smooth muscle relaxants Probiotics Food supplements Laxatives Anti-diarrhoea products Natural / herbal products / supplements [GENERAL SALE] eg, peppermint oil (Colpermin, Mintec*) [PHARMACIST ONLY MEDICINE] eg, hyoscine (Gastro-Soothe*) [SUPPLEMENT] eg, IBS Support, Primadophilus Reuteri eg, gluten-free wheat dextrin (Benefiber) eg, inulin fibre (Metamucil Fibresure) [GENERAL SALE] eg, docusate (Coloxyl), lactulose (Laevolac), psyllium husk (Metamucil), sterculia (Normacol) [PHARMACY ONLY MEDICINE] eg, loperamide (Diamide, Imodium Zapid) eg, guar gum, kiwifruit extract, peppermint, slippery elm, turmeric Peppermint oil provides natural relief of abdominal bloating, distension and cramping. May be helpful for abdominal pain or cramping. May help to regulate the digestive system, reduce abdominal pain and bloating, and encourage more uniform stools. Studies have indicated a benefit for probiotics species such as Bifidobacterium, Lactobacillus, and Propionibacterium. Fine powder with minimum taste. Can be sprinkled on foods and in cooking without premixing to increase fibre content of the diet, encouraging more uniform stools. Most laxatives only treat constipation; however, bulk-forming laxatives (containing psyllium or sterculia) can also be used to bulk up watery unformed stools. When used to regulate stool consistency, less water can be drunk as the fibre absorbs fluid from the bowel. See Constipation for more information about constipation. Slow down bowel movements, allowing reabsorption of fluid by body. Can help reduce cramping, abdominal pain and the frequency of bowel motions. May be used regularly in people with IBS to regulate ongoing diarrhoea. Many natural ingredients (including probiotics, guar gum, peppermint, turmeric) have been shown to be effective in IBS. Kiwifruit extract contains prebiotics, enzymes and dietary fibre to optimise bowel health. Products with an asterisk have a detailed listing in the Irritable Bowel Syndrome section of OTC Products, on page 250. Page 102 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION Initial assessment Politely ask customers who you notice repeatedly purchasing laxatives or anti-diarrhoea products if they would like to talk their condition over with a pharmacist. Symptoms of IBS are similar to many other conditions, some more serious than others, and it is important to refer anybody with obvious RED FLAGS (see Refer to Pharmacist) or with an undiagnosed condition to a doctor. Treatments IBS cannot be diagnosed until other conditions such as coeliac disease, diverticulitis, or inflammatory bowel disease have been ruled out. Other tests – such as a sigmoidoscopy or colonoscopy – may also be needed. For this reason it is important all customers without a formal diagnosis be referred to a doctor, particularly those customers with RED FLAGS (see Refer to Pharmacist). Once the diagnosis has been established, diet and lifestyle changes should be tried first. People with IBS should try eating smaller, scheduled meals throughout the day, rather than just three big meals. Food should be eaten slowly and care should be taken to avoid meals that are likely to over-stimulate the gut, such as high-fat foods or large meals. Scientific studies have shown that a low-FODMAP diet can significantly relieve IBS symptoms for many sufferers. FODMAP is an acronym for the indigestable sugars that can cause the bowel to distend by drawing in more fluid and rapidly generating gas when fermented by bowel bacteria: • Fermentable – those sugars that are rapidly broken down by bowel bacteria • Oligosaccharides – fructans and galacto-oligosaccharides • Disaccharides – lactose • Monosaccharides – fructose • And • Polyols – mannitol, maltitol, sorbitol, xylitol. However, these diets are not suitable for everybody with IBS and can be difficult to follow as well as being restrictive nutritionally. Seek expert advice (for more information see Other lifestyle changes include avoiding triggers, learning how to handle stress and increasing physical activity. Medication may also be used to manage IBS. Doctors may treat IBS that has developed following a gastroenteritis illness with antibiotics or probiotics although it typically takes one to two years for the condition to completely resolve. Other treatments target the most predominant symptom (ie, constipation or diarrhoea) and most treatments are given only when needed. Stronger medicines are available on prescription. Refer to PHARMACIST Refer to the pharmacist anybody who has not had the diagnosis of IBS confirmed by a doctor. RED FLAGS (ALARM SIGNALS) – REFER TO A DOCTOR • Abdominal or rectal mass • Family history of gastrointestinal cancer, inflammatory bowel disease or coeliac disease • Iron deficiency anaemia • Onset of symptoms in patients aged greater than 50 years • Nocturnal symptoms (eg, waking from sleep with pain or the need to defecate) • Rectal bleeding that is not due to haemorrhoids • Unintentional or unexplained weight loss. For all other customers with previously diagnosed IBS, ask the following questions, if appropriate, and refer any people with “yes” answers to a pharmacist. • Is there any rectal bleeding or blood mixed into the stools? • If constipation is present, is it severe or has it persisted for longer than a week? • Do the stools float or are they hard to flush down the toilet? • Are there other symptoms (eg, fever)? • Could the person be anaemic? • Has the person lost a significant amount of weight recently? • Do the symptoms wake the person at night? • Have the symptoms become worse over time or changed recently? • Has the person recently travelled overseas? • Does the person have any allergies to medicines? Page 103

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