Damien O’Brien MPSI provides a synopsis of digestive health, common presentations, and the role of the pharmacist
Introduction
Digestive health refers to the proper functioning of the gastrointestinal (GI) tract – where food is efficiently broken down, nutrients are absorbed, and waste is eliminated. It also encompasses the balance and diversity of the gut microbiome, which plays an increasingly recognised role in overall health. Good digestive health reflects a state in which the GI tract operates in harmony with the rest of the body, free from disruptive symptoms or disease.
Pharmacies are often the first point of contact for patients with common complaints such as indigestion, bloating, heartburn, diarrhoea, and constipation. These symptoms can range from mild and self-limiting to chronic and life-changing.
Studies suggest that up to four- in-10 people live with functional gastrointestinal disorders – such as irritable bowel syndrome (IBS) or functional dyspepsia – with many going undiagnosed or self-treating without professional input. Functional GI conditions are a group of conditions where the digestive tract doesn’t function properly, causing symptoms despite the absence of identifiable structural or biochemical abnormalities.
Pharmacists play an important role in offering early advice, over-the-counter (OTC) treatment, lifestyle guidance, pharmacological support, and timely referral when red flags appear. This article
explores the importance of digestive health, common GI presentations, treatment options, the gut microbiome, relevant lifestyle factors, and the growing role of pharmacists in supporting digestive wellbeing.
The importance of digestive health
Digestive health is increasingly recognised as a cornerstone of physical and mental wellbeing. The gut acts as a dynamic interface between the external environment and the body’s internal systems. The gut microbiome is a diverse ecosystem of microbes that impact everything from metabolism and immune function to brain function. Disruption to this microbial balance is associated with chronic inflammation, insulin resistance, cardiovascular disease, and neurodegenerative disorders.
Over 70 per cent of the immune system resides in the gut-associated lymphoid tissue (GALT), where immune cells continuously engage with microbial signals. This interaction supports immune tolerance and helps prevent inappropriate inflammatory responses, underscoring the central role of gut integrity in immune regulation. The integrity of the intestinal epithelial barrier is vital; when compromised, it may allow the passage of pathogens and toxins into the bloodstream, promoting systemic inflammation and increasing the risk of chronic disease.
The gut-brain axis is a bidirectional communication pathway between the gut and the central nervous system (CNS), which further highlights the systemic importance of digestive health. Imbalances in the microbiome have been linked to changes in mood, cognitive
Prebiotics are fermentable fibres that promote the growth
of beneficial bacteria
function, and mental health conditions such as anxiety and depression. Mental and physical health are increasingly understood to be closely intertwined with gut function.
A healthy gut ensures efficient digestion and nutrient absorption, supporting metabolism, hormonal balance, and musculoskeletal health. Conversely, impaired digestive health can lead to fatigue, pain, dietary limitations, social withdrawal, and chronic disease, all of which reduce quality of life.
These impacts make it increasingly important for pharmacists to recognise how gastrointestinal symptoms often intersect with broader physical and psychological health concerns.
Promoting good digestive health
Supporting digestive health begins with understanding the crucial role
of the gut microbiome. This complex ecosystem of microorganisms contributes to digestion, metabolic regulation, and immune modulation. These microbes assist in breaking down complex carbohydrates, support the synthesis of B and K vitamins, and help maintain the intestinal barrier. They also engage with immune cells, modulating inflammation and responding to pathogens. An imbalance in this system – known as dysbiosis – has been associated with conditions such as inflammatory bowel disease, obesity, metabolic syndrome, and mood disorders.
In this context, interest in probiotic and prebiotic supplements has grown substantially in recent years. Probiotics are live microorganisms that provide health benefits when taken in adequate amounts. Prebiotics are fermentable fibres that promote the growth of beneficial bacteria. Evidence supports the use of certain strains, such as Lactobacillus and Bifidobacterium, in managing conditions like antibiotic- associated diarrhoea, IBS, and aspects of immune function.
However, clinical results are variable, and effectiveness depends on both the strain used and the condition being treated.
Pharmacists play a key role in advising patients, particularly as not all products on the market contain evidence-based strains or effective doses. They can guide patients by advising on product selection, appropriate indications, expected outcomes, and correct storage. Relying on recognised clinical reviews and emerging evidence allows pharmacists to provide informed and balanced guidance. While supplementation may have a place, a diverse, fibre-rich diet remains the foundation of a healthy microbiome.
Digestive health is strongly influenced by modifiable lifestyle and dietary behaviours. These factors play a central role in shaping the gut microbiota, supporting motility, and managing symptoms of functional gastrointestinal disorders. A diverse, fibre-rich diet helps to maintain microbial diversity, gut barrier function, and regular bowel movements.
Irish and European guidelines recommend a daily fibre intake of 25-to-30g for adults, though many individuals consistently fall short of this target. A balanced dietary pattern – rich in vegetables, fruits, legumes, nuts, and whole grains, and limited in ultra-processed foods – is associated with reduced gut inflammation and improved metabolic health.
Fermented foods such as yoghurt, kefir, and kimchi may provide beneficial microbes, though current evidence is still emerging and more high-quality trials are needed.
Several lifestyle factors also influence digestive function. Regular physical activity stimulates bowel motility and supports microbial diversity. Even low- intensity activity, such as walking, may relieve symptoms of constipation.
On the other hand, smoking and excessive alcohol intake negatively impact gut function. Smoking disrupts microbial balance, impairs mucosal healing, and increases the risk of Crohn’s disease. Alcohol may damage the intestinal lining, increase permeability, and exacerbate symptoms of reflux and IBS.
Chronic psychological stress affects the gut-brain axis by altering motility, pain sensitivity, and microbial composition. In addition, sleep disturbances have been increasingly linked to disruptions in gut microbial patterns.
Pharmacists are well placed to support patients with practical, evidence- informed lifestyle advice. By countering misinformation and encouraging sustainable strategies, they can help patients adopt long-term behaviours that promote digestive wellbeing.
Common gastrointestinal complaints in the pharmacy Digestive complaints are among the most frequent reasons for community pharmacy consultations, ranging from short-term discomfort to symptoms of more complex or chronic conditions. Pharmacists are ideally placed to provide first-line advice, recommend appropriate treatments, and recognise when referral is needed.
Gastro-oesophageal reflux disease (GORD) is a condition characterised by the retrograde flow of stomach contents into the oesophagus, leading to inflammation of the oesophageal mucosa. It typically presents with heartburn and acid reflux, and is often worse at night or after meals. These symptoms are often triggered by fatty or spicy foods, alcohol, smoking, caffeine, and lying flat shortly after eating.
Short-term use of alginate-containing antacids or proton pump inhibitors (PPIs) can provide effective relief. Patients should be counselled on correct dosing and time of administration, with PPIs such as omeprazole and esomeprazole available OTC.
Lifestyle modifications – such as spacing meals, elevating the head of the bed, avoiding food two-to-three hours before bedtime, maintaining a healthy weight, and limiting smoking, alcohol and trigger foods – are also important.
Red flag symptoms include persistent symptoms beyond four weeks, dysphagia, unexplained weight loss, and haematemesis, which require urgent referral.
Constipation and diarrhoea are also common presentations in the pharmacy. Constipation is often linked to inadequate fibre or fluid intake, physical inactivity, or medications such as opioids, iron, and anticholinergics. Bulk-forming laxatives (ispaghula husk) are often used as first-line treatment, with osmotic (lactulose and macrogol) or stimulant options (senna and bisacodyl) used as needed.
Diarrhoea is often caused by diet, infection, stress, or recent medication changes. Loperamide may offer short- term relief, but referral is needed if symptoms persist beyond 48 hours or are accompanied by blood or mucus in stool, dehydration, or recent travel history. A thorough medication and dietary history support safe and effective advice.
IBS is a functional gut disorder presenting with abdominal pain, bloating, and altered bowel habits, without an identifiable underlying cause. It is a prevalent and chronic condition influenced by gut-brain interaction and often exacerbated by stress. Symptoms vary, with some patients experiencing ongoing discomfort and others reporting intermittent flare-ups. Pharmacists can help patients identify symptom patterns and offer guidance on lifestyle changes, dietary triggers, and treatment options.
Treatment strategies range from pharmacological intervention to dietary and lifestyle modifications,
with individualised management being essential. Antispasmodics such as mebeverine or peppermint
oil may relieve cramping, while fibre supplementation can help manage constipation. Red flags include symptom onset after age 55, unexplained weight loss, fever, anaemia, rectal bleeding, and nocturnal symptoms, all of which require prompt medical evaluation.
Pharmacists play a crucial role in managing GI complaints, from symptom relief to red flag identification. With structured questioning, sound clinical judgement, and appropriate referral, they help improve outcomes for patients with digestive health concerns.
The pharmacist’s role
Pharmacists are uniquely positioned to support digestive health through accessible and evidence-based care. As frontline healthcare professionals, they are often the first point of contact for individuals experiencing GI symptoms. Whether managing short-term gastrointestinal issues or providing longer-term advice for chronic conditions, pharmacists play a vital role in guiding appropriate self-care, recommending appropriate OTC treatment, and recognising when medical referral is necessary.
Pharmacists contribute to the broader picture of digestive health beyond symptom management. Supporting patients with smoking cessation, weight management, stress reduction, and healthy eating is essential to maintaining gut function and preventing disease. Pharmacists help identify potentially serious underlying conditions. Recurring GI complaints that fail to respond to treatment may be a sign of conditions such as coeliac disease, inflammatory bowel disease, or GI malignancy. Awareness of symptom patterns, age of onset, and clinical red flags enables pharmacists to prompt timely referral and appropriate escalation.
Collaboration with GPs, dietitians, and other healthcare professionals enhances continuity of care and ensures patients receive comprehensive holistic support. With rising public interest in gut health, pharmacists are ideally placed to provide reliable information, counter misinformation, and empower individuals with
trusted guidance. Digestive health is a cornerstone of overall health and wellbeing, and pharmacists are at the forefront of promoting it.
References available upon request
