Help Patients Determine When to Seek Medical Care for GI Issues

Mild to moderate digestive issues occur from time to time, and most can be effectively managed with a nonprescription gastrointestinal (GI) medication.

However, some individuals regularly experience bothersome GI problems, such as acid reflux, bloating, constipation, diarrhea, and indigestion that can adversely affect quality of life. Those who have frequent and/or severe GI symptoms, continual symptoms, or whose symptoms worsen despite self-treatment should seek immediate medical evaluation. Left untreated, some GI issues can lead to serious conditions.

Unfortunately, many individuals who experience GI symptoms are often reluctant or uncomfortable about discussing these issues with their primary care providers (PCPs) or they do not perceive them as significant. The results of a recent survey regarding common GI-related issues involving more than 2000 US. adults showed that:¹

• 89% reported that improper diet may be a contributing factor.
• 74% indicated that they tolerated the GI symptoms for more than 6 months, and 37% of those consulted their PCPs after dealing with symptoms for more than 6 months.
• 72% experienced at least one of the following GI symptoms a few times a month or more: abdominal pain, bloating, diarrhea, flatulence, frequent bowel movements, nonspecific GI discomfort, and unexplained weight loss.
• 73% reported that the GI symptoms cause frustration.
• 56% indicated that they did not discuss GI symptoms with their PCPs because they thought they did not warrant medical care.
• 24% of those who consulted their PCPs received a diagnosis, and 11% sought care 2 or more times before receiving a diagnosis.

Additionally, more than 60 million Americans experience heartburn at least once a month, according to the National Institutes of Health, and some data suggest that more than 15 million Americans experience heartburn symptoms daily.^2,3

An estimated 33% of the world’s population experiences some type of digestive symptoms, most commonly bloating and constipation, according to the World Gastroenterology Organization.⁴

Moreover, less than 20% of individuals with abdominal pain, bloating, or diarrhea consult a PCP for evaluation and management.⁵

Recent Clinical Studies and News

The results of a new study published in the journal Cancer Epidemiology, Biomarkers, & Prevention showed that the incidence of colon cancer is increasing among individuals in their 20s, with many diagnosed with advanced stages.⁶

The results also showed that colononly distant adenocarcinoma increased 49% among Americans in their 30s.⁶ Possible contributing factors may include obesity, sedentary lifestyles, and smoking.⁷

A study published in Gastroenterology examined a large, nationally representative data set of about 3 million outpatient colonoscopies to ascertain the incidence of, and risk factors for, colorectal neoplasia among patients aged 18 to 54 years.

“Our present analysis of neoplastic colorectal pathology among individuals younger than age 50 suggests that lowering the screening age to 45 for men and women of all races and ethnicities will likely detect important pathology rather frequently,” the investigators said. “Early messaging to patients and providers in the years leading up to age 45 is warranted, especially in those with a family history of [colorectal cancer].”⁸

The results of another study published in the Journal of Clinical Gastroenterology showed that an estimated 50% of participants surveyed indicated that their irritable bowel syndrome symptoms, like abdominal pain, constipation, or diarrhea, worsened during the pandemic.⁹ Investigators indicated that contributing factors, such as anxiety and/or depression, may have led to surges in symptoms.⁹

Findings from these studies as well as data from various publications highlight the need to expand patient education initiatives about the importance of digestive health in overall health and to increase awareness about the signs and symptoms of serious GI-related conditions and when to seek further evaluation.

Conclusion

Because of their accessibility and drug expertise, pharmacists can help patients select nonprescription GI products, ascertain the appropriateness of their use, and encourage those with chronic and/or recurring GI symptoms to seek further medical evaluation and treatment. Many patients with mild to moderate GI problems like as constipation, diarrhea, flatulence, heartburn, and indigestion, choose to self-treat with OTC products, but pharmacists should encourage them to seek medical care when warranted.

Pharmacists can help identify patients at risk for or exhibiting signs and symptoms correlated with medical conditions that may necessitate additional or immediate medical evaluation and treatment. Examples of these signs and symptoms may include:

• changes in bowel habits, especially chronic con- stipation or diarrhea;
• changes in the consistency of the stool, especially if accompanied by unexplained weight gain or loss;
• difficulty swallowing;
• persistent abdominal discomfort, distention, and/or pain;
• persistent and/or severe dyspepsia and heartburn, nausea, and vomiting; and
• signs of rectal bleeding or blood and or mucus in the stool.

Pharmacists can also encourage patients to be proactive about their digestive health and discuss their risks for GI conditions with their PCPs. Because various studies have indicated that colon cancer is on the rise, especially among younger patients, and partly because of delays in screenings during the pandemic, it is imperative that pharmacists seize every opportunity to encourage patients to discuss colon cancer risk and preventive measures with their PCPs.

Pharmacists can also remind patients that colorectal cancer screenings are generally recommended starting at aged 45 years, possibly earlier in individuals with an increased risk.

As the gatekeepers of proper and safe use of medications, pharmacists can give guidance about the correct use of products for digestive health and for prevention and treatment of those mild to moderate GI ailments amenable to self-treatment. Pharmacists can also remind patients about nonpharmacological measures that can promote GI health, such as consuming fiber, eating a balanced diet, exercising when appropriate, maintaining a healthy weight, not smoking, reducing stress, and staying hydrated.

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

References

1. New survey reveals more than half of Americans are living with gastrointestinal symptoms and not seeking care from a doctor. News release. AbbVie. November 6, 2013. Accessed March 8, 2022. https://news.abbvie.com/news/new-survey-reveals-more-than-half-americans-are-living-with-gastrointestinal-symptoms-and-not-seeking-care-from-doctor.htm

2. Digestive diseases. National Institute of Diabetes and Digestive and Kidney Diseases. 2021.Accessed March 16, 2022. https://www.niddk.nih.gov/health-information/digestive-diseases

3. 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/

4. Digestive health resources. World Gastroenterology Organisation. Accessed March 16, 2022. https://wdhd.worldgastroenterology.org/digestive-health-resources

5.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

6. Montminy EM, Zhou M, Maniscalco L, et al. Shifts in the proportion of distant stage early-onset colorectal adenocarcinoma in the United States. Cancer Epidemiol Biomarkers Prev. 2022;31(2):334-341. doi:10.1158/1055-9965.EPI-21-0611

7. Why is colorectal cancer rising rapidly among young adults? National Cancer Institute. November 5, 2020. Accessed March 3, 2022. https://www.cancer.gov/news-events/cancer-currents-blog/2020/colorectal-cancer-rising-younger-adults

8.Trivedi PD, Mohapatra A, Morris MK, et al. Prevalence and predictors of young-onset colorectal neoplasia: insights from a nationally representative colonoscopy registry. Gastroenterol. 2022;S0016-5085(22)00005-1. doi:10.1053/j.gastro.2021.12.285

9.Kamp KJ, Levy RL, Munson SA, Heitkemper MM. Impact of COVID-19 on individuals with irritable bowel syndrome and comorbid anxiety and/or depression. J Clin Gastroenterol. 2022;56(2):e149-e152. doi:10.1097/MCG.0000000000001515