Kathy Oxtoby explores this £100m market ranging from indigestion to irritable bowel syndrome
“A patient kept coming to the pharmacy for indigestion remedies. An MUR picked up an underlying problem. So we referred them to their GP and the diagnosis was gastric cancer, which was caught in time,” recalls Sukhy Somal, services support manager for Midcounties Co-operative Pharmacy.
As Ms Somal’s experience shows, digestive health is not only a large part of pharmacy business – covering such conditions as indigestion, bloating and constipation – but an opportunity to identify warning signs of more serious conditions where swift intervention could save lives.
Daniel Patterson, pharmacist at the Co-operative Pharmacy, Biddulph, Stoke-on-Trent, believes this category offers the profession the satisfaction of being able to provide treatments that can bring “immediate relief for patients with such distressing conditions as indigestion, diarrhoea and constipation”.
According to data analyst Kantar Worldpanel, pharmacy’s share of the indigestion and stomach upset market has fallen to 27 per cent on the back of a sales decline (see Market Insight, right). However, POM to P switches of products such as Pantoloc Control and Zanprol, which help to reduce stomach acid, and Buscopan Cramps, which is designed to relieve abdominal cramps (see Product Watch, p32), give the profession an opportunity to offer treatments for digestive health problems that are not available on the supermarket shelf.
The chance to sell such products also means pharmacists can have conversations with customers to help them in the short-term, rather than having to make an appointment with their GP, says Ms Somal.
Some pharmaceutical companies are also developing indigestion products to make them more palatable to customers. “One of the main problems with indigestion/reflux tablets is the fact that they can taste chalky or gritty. Gaviscon has recently launched Gaviscon Strawberry Tablets, which have been developed to tackle these consumer perceptions,” says a spokesperson from Gaviscon.
With so many products for customers to choose from, pharmacists need to ensure staff have the right training to meet their needs. Pharmaceutical companies such as GSK offer online training for pharmacy assistants, including tools to aid counselling for conditions such as constipation. “This is a delicate subject, so pharmacists should offer communications training, including looking at patient body language, so staff have the right skills to manage this category in a professional way,” says Croydon pharmacist Shailesh Amin.
Staff should also be encouraged to think about digestive health not just in terms of a single product sale, but as a chance to treat side effects. “For example, when a customer buys a product to treat diarrhoea, staff should ask whether they are eating and drinking, and if they need a rehydration product. It’s not just about one condition – other products may also help,” says Ms Somal.
Pharmacists should also view seeing patients with digestive problems as a chance to identify more sinister conditions. “You need to build a picture of the patient. When someone is always coming in for cream for piles or constipation relief we need to find out why,” says Ms Somal.
She advises pharmacists to flag up warning signs, such as blood in the stools, so they can refer customers to their GP to make sure their symptoms are not masking more long-term or serious problems.
Pharmacists can also play an important role in providing dietary, exercise and lifestyle advice to patients. Mimi Lau, director of professional services for Numark, says: “We are often in danger of focusing too much on the right treatment or cure, but we should also be thinking about prevention – and this is an ideal area for our input. So, for instance, we should help identify the triggers for IBS with a patient.”
Simple information about a healthy diet “can help people take control of their problems and save them from suffering from chronic conditions”, says Boots pharmacist Angela Chalmers, who manages the multiple’s Goodge Street branch in London.
Mr Patterson stresses the importance of the consultation room to discuss customers’ issues in a private environment.
“Being able to talk one-to-one means we use our skills to help patients to get to the root cause of their problems and suggest products to help them,” he says.
Indigestion can be a confusing category for customers, so pharmacists should try to ensure their merchandising strategy makes the selection process as easy as possible, Ms Henshaw says. Indigestion remedies should be in a prominent place and signposting should be used to help customers navigate the various sub-categories.
She advises that H2 receptor antagonists need to have their own designated space allocation as they have a different active ingredient and should be merchandised accordingly. Merchandise with all upper and low GI sections next or near to each other, including anti-diarrhoeal, laxatives and rehydration treatments, she suggests.
Mr Patterson says pharmacists can also promote the digestive health category on a seasonal basis – for example, smaller packs of indigestion and diarrhoea packs can be placed near summer travel products.
For Mr Amin, this category is one of the most satisfying for pharmacy. “With digestive health we not only have an armoury of products that means we can offer instant relief – it also allows us to provide lifestyle advice, and prove to the public we’re not just drug specialists, but also experts in managing treatments.”
Market Insight: Stomach upset and indigestion
The indigestion and stomach upset market is in slight year-on-year decline of 0.6 per cent, which has improved when compared to the -1.3 per cent performance in the year to September 5, 2010. It is dominated by the indigestion category, which accounts for over 90 per cent of the sales.
While shopper numbers are down year-on-year, the downward trend has stabilised from July. On average, shoppers have spent £8.23 per year. This has gone backwards, partly due to a drop in average spend to £8.17 in December that reflects increased promotional activity over the ‘indulgence’ period.
Own label continues to grow share, accounting for just over 20 per cent. However, customers are buying fewer packs (4.9 per cent less compared with 2 per cent less on branded), and paying more for the product. The average price of own label is £1.96, up 13.5 per cent year-on-year; this compares with £2.97 on brands, down 0.5 per cent.
Pharmacies’ share of indigestion and stomach upset has fallen to 27.3 per cent on the back of a sales decline. That said, Boots is still the clear number two retailer in this sector, with nearly 15 per cent of spend.
There is a continuation of customer numbers in pharmacies falling. This is offset by the fact they are spending more each time they visit through trade-up within brands.
Total market value
£91.7 million -0.6%
£3 million -6.1%
Total market value
£9.4 million +3.2%
£24.7 million -2.1%
Branded vs own label
Indigestion and stomach upset
£80.6 million -2.5%
£20.5 million +7.9%
Source: Kantar Worldpanel, 52 weeks to January 23, 2011. Data and analysis provided for C+D by Kantar Worldpanel (strategic insight director Tim Nancholas)
Best-selling indigestion and stomach upset brands
4 Andrews Liver Salts
6 Alka Seltzer
9 Milk of Magnesia
5 tips for boosting your digestive health service
1. “This is a vast category so you need to understand exactly what problem your customer has – whether it’s heartburn or IBS – so you can offer the right treatment.”
Sukhy Somal, services support manager, Midcounties Co-operative Pharmacy
2. “Know about the latest digestive health products, and make sure you offer training for staff about them before they go in store.”
Samiah Tambra, pharmacist manager, Midcounties Co-operative Pharmacy, Pennfields, Wolverhampton
3. “Keep it simple. Easy adjustments to diet, such as eating a bowl of high fibre cereal and a tangerine, and drinking a large tumbler of water, gives patients realistic goals to ease their constipation.”
Angela Chalmers, pharmacist manager, Boots, Goodge Street, London
4. “See customers in your consultation room to give them the opportunity to ask questions about their condition, to avoid them feeling embarrassed talking about what are often taboo subjects.”
Daniel Patterson, pharmacist,
Co-operative Pharmacy, Biddulph,
5 “Refer customers to their GPs if they suffer from indigestion regularly or if it causes severe pain and discomfort. They could be suffering from a hiatus hernia, helicobacter pylori infection or a peptic ulcer.”
Lynne Henshaw, director of marketing, Numark
Midcounties Co-operative Pharmacy, Pennfields, Wolverhampton
“Last year, when we remerchandised the pharmacy, we decided to make a special feature of digestive health. Recent POM to P switches mean we can offer more products in store. The category also gives us the opportunity to offer advice and support that customers won’t find in their supermarket.
“Our digestive health fixture displays a wide variety of products, from anti-spasmodics to constipation treatments, allowing patients to look at the range without having to approach the counter to ask embarrassing questions. Leaflets about various digestive problems, such as irritable bowel syndrome and stomach cramps, are also part of the display to give customers information about these conditions.
“As well as making digestive health treatments easily accessible for customers, we also make sure staff know about new product developments, providing relevant training to ensure they can offer the latest advice and ask the right questions effectively and with sensitivity.
“We also take part in awareness campaigns such as Bowel Cancer Awareness Month and IBS Awareness Month. It’s all about demystifying digestive health and educating people about their ailments and how to manage them in the best way. Often, people don’t deal with their digestive problems until it gets to the point they need to see their GP. But it might be that their condition could have been better controlled – and pharmacy is ideally placed to offer preventative measures, which also frees up GP time.”
Manufacturer: Boehringer Ingelheim
For: The relief of abdominal cramps
Active ingredients: Hyoscine butylbromide
Contraindications: Buscopan Cramps should not be administered to patients with myasthenia gravis, megacolon and narrow angle glaucoma. They should not be given to patients with a known hypersensitivity to hyoscine butylbromide or any other component of the product
Tel: 01923 229251
Format/pack size: 20 tablets
Pip code: 353-1738
Manufacturer: Boehringer Ingelheim
For: The relief of constipation
Active ingredients: Macrogol 4000
Contraindications: Severe inflammatory bowel disease (such as ulcerative colitis, Crohn’s disease) or toxic megacolon, associated with symptomatic stenosis; digestive perforation or risk of digestive perforation; ileus or suspicion of intestinal obstruction; painful abdominal syndromes of indeterminate cause; hypersensitivity to macrogol (polethylene glycol) or to any of the excipients
Tel: 01923 229251
Format/pack size: 10 sachets
Pip codes: 353-1746
Manufacturer: Novartis Consumer Health
For: Relief for frequent heartburn and acid reflux sufferers; one tablet can suppress acid secretion for up to 24 hours
Active ingredients: Pantoprazole 20mg
What’s new? Pantoloc Control was launched last spring, supported by a £2m advertising campaign, following 2009’s approval of the POM to P reclassification of PPI (proton pump inhibitor) pantoprazole
Contraindications: Hypersensitivity to the active substance, to soya or to any of the other excipients; co-administration with atazanavir
Tel: 01403 218111
Format/pack size: Gastro-resistant tablets: 7; 14
Pip codes: 354-5449; 354-5456
RRP: £7.05; £12.15
Available for nearly 30 years, Dioralyte continues to be “the best selling oral rehydration therapy”, says Ros Munday, OTC commercial manager for Sanofi Aventis.
The travel sector is an important market for the brand, Ms Munday says, with the sachet format of Dioralyte making it easy to take on holiday abroad, where food poisoning and dehydration risks are high.
Ms Munday expects Dioralyte sales to be strong in the spring, especially among parents “as rotavirus is easily spread among children under five, within nurseries and at school”.
Extensions to the brand include Dioralyte Relief, which contains rice starch, to reduce the duration of diarrhoea, and the latest development in the range – Oralyte, a ready-to-drink oral rehydration therapy.
“Oralyte is marketed for parents to buy for their children, due to the improved blackcurrant flavour, making it easier for children to stay hydrated on the go. The stand-out, attractive, colourful packaging is appealing to children and parents, highlighting the ease of use with great tasting flavour,” says Ms Munday.
The launch activity for Oralyte will include a trade and consumer advertising campaign, as well as product information and training materials for pharmacy staff.
Reflect Do my patients get the most out of digestive health products?
Plan Review common digestive presentations, and my and my staff’s knowledge and sales protocols.
Act Read this article, and review available training as necessary.
Evaluate Do my patients get better digestive health advice?[source]