Functional dyspepsia and the role of digestive enzymes supplement in its therapy
Keywords:Amylase, Functional dyspepsia, Lipase, Oral digestive enzymes supplement, Pepsin
Functional dyspepsia represents a heterogeneous group of gastrointestinal disorders marked by the presence of upper abdominal pain or discomfort. Reported prevalence of dyspepsia in the world varies from 11-30%. Basic Pathophysiology of functional dyspeptic symptoms is unclear and is considered to occur due to a combination of visceral hypersensitivity, gastric motor dysfunction and psychological factors. Strategies such as acid suppression, prokinetics and H. pylori eradication have been used with some success. Transient deficiency in digestive enzymes is one of the contributors for functional dyspepsia. The primary digestive enzymes are proteases, amylases and lipases. A commonly used therapeutic approach in its treatment is the use of oral enzymes supplementation therapy. Commercially, digestive enzymes are obtained from plant, animal and microbial sources. This review summarizes the pathophysiology of functional dyspepsia, different pharmacological approaches and focuses on the safety and efficacy of digestive enzymes in managing dyspepsia. Keywords including functional dyspepsia, digestive enzymes, lipase, diastase, papain, pepsin, trypsin and chymotrypsin were searched in databases such as Google, Google Scholar, PubMed, pharmacopoeia and textbooks.
Mearin F, Calleja JL. Defining functional dyspepsia. Rev Esp Enferm Dig. 2011;103(12):640-7.
Talley NJ, Ford AC. Functional Dyspepsia. N Engl J Med. 2015;373(19):1853-63.
Talley N, Stanghellini V, Heading R, Koch K, Malagelada J, Tytgat G. Functional gastroduodenal disorders. Gut. 1999;45(2):1137-42.
Drossman DA. The Functional Gastrointestinal Disorders and the Rome III Process. Gastroenterology. 2006;130(5):1377-90.
Mahadeva S, Goh KL. Epidemiology of functional dyspepsia: A global perspective. World J Gastroenterol. 2006;12(17):2661-6.
Fang YJ, Liou JM, Chen CC, Lee JY, Hsu YC, Chen MJ. Distinct aetiopathogenesis in subgroups of functional dyspepsia according to the Rome III criteria. Gut. 2015;64(10):1517-28.
Choung RS, Talley NJ. Novel mechanisms in functional dyspepsia. World J Gastroenterol. 2006; 12(5):673-7.
Kaminski A, Kamper A, Thaler K, Chapman A, Gartlehner G. Antidepressants for the treatment of abdominal pain-related functional gastrointestinal disorders in children and adolescents. [Internet]. In: Cochrane Database of Systematic Reviews. John Wiley and Sons, Ltd; 2011.
Samsom M, Verhagen MA, VanBerge H, Smout AJ. Abnormal clearance of exogenous acid and increased acid sensitivity of the proximal duodenum in dyspeptic patients. Gastroenterology. 1999;116(3):515-20.
Kusunoki H, Haruma K, Manabe N, Imamura H, Kamada T, Shiotani A, et al. Therapeutic efficacy of acotiamide in patients with functional dyspepsia based on enhanced postprandial gastric accommodation and emptying: randomized controlled study evaluation by real-time ultrasonography. Neurogastroenterol Motil. 2012;24(6):540-5.
Matsueda K, Hongo M, Tack J, Saito Y, Kato H. A placebo-controlled trial of acotiamide for meal-related symptoms of functional dyspepsia. Gut. 2012;61(6):821-8.
Du LJ, Chen BR, Kim JJ, Shen JH, Dai N. Helicobacter pylori eradication therapy for functional dyspepsia: Systematic review and meta-analysis. World J Gastroenterol. 2016;22(12):3486-95.
Banka N, Sawant P, Vartak M, Pawar D. Efficacy and Tolerability of Unienzyme MPS- A Multienzyme Preparation with Simethicone in Patients with Non-ulcer ,Dyspepsia. Indian Medical Gazette. 2001;135(7):294-305.
Khandke DA, Shirsath PA, Jain SK. Post-Marketing Surveillance Study to Assess the Efficacy and Tolerability of Al5zyme-A Multienzyme Preparation in Patients with Functional Dyspepsia. Indian Medical Gazette. 2013;181-91.
Laugier R, Bernard JP, Berthezene P, Dupuy P. Changes in pancreatic exocrine secretion with age: pancreatic exocrine secretion does decrease in the elderly. Digestion. 1991;50(3-4):202-11.
Feldman M, Cryer B, McArthur K, Huet BA, Lee E. Effects of aging and gastritis on gastric acid and pepsin secretion in humans: a prospective study. Gastroenterology. 1996;110(4):1043-52.
Sweetman S. Eds. Martindale; Amylase In: The Complete Drug reference. The Pharmaceutical Press: London; 2009:2256.
Sivaramakrishnan S, Gangadharan D, Nampoothiri KM, Soccol CR, Pandey A. Alpha amylase production by Aspergillus oryzae employing solid-state fermentation. JSIR. 2007;668.
Dhital S, Lin AH-M, Hamaker BR, Gidley MJ, Muniandy A. Mammalian Mucosal α-Glucosidases Coordinate with α-Amylase in the Initial Starch Hydrolysis Stage to Have a Role in Starch Digestion beyond Glucogenesis. PLoS ONE. 2013;8(4).
Pepsin. In: Sweetman S. Eds. Martindale, The Complete Drug reference. The Pharmaceutical Press: London; 2009:2362.
Trypsin. In: Sweetman S. Eds. Martindale, The Complete Drug reference. The Pharmaceutical Press: London; 2009:2362.
Chymotrypsin. In: Sweetman S. Eds. Martindale, The Complete Drug reference. The Pharmaceutical Press: London; 2009:2362.
Smith RG. Enzymatic debriding agents: an evaluation of the medical literature. Ostomy Wound Manage 2008;54(8):16-34.
Lee J, Anderson R. Proteolytic enzymes for oesophageal meat impaction. Emerg Med J. 2005; 22(2):122-3.
Lipase. In: Sweetman S. Eds. Martindale, The Complete Drug reference. The Pharmaceutical Press: London; 2009:2362.
Hasan F, Shah AA, Hameed A. Industrial applications of microbial lipases. Enzyme Microb Technol 2006;39(2):235-51.
Salihu A, Alam MZ, Abdul Kalim MI, Salleh HM. Characterization of Candida cylindracea lipase produced from Palm oil mill effluent based medium. IJCBS. 2012;2:24-31.
Levine ME, Koch SY, Koch KL. Lipase Supplementation before a High-Fat Meal Reduces Perceptions of Fullness in Healthy Subjects. Gut Liver. 2015;9(4):464-9.
Deyneko N, Sirodza O, Voytsekhova L, Usenko L, Skalozub T, Usenko V. Use Of "Unienzymewith Mps" In the Complex Treatment of Chronic Diseases of Digestive System] Use Of "Unienzyme With Mps" In The Integrated Treatment Of Chronic Diseases Of Digestive Bodies. Use Of "Unienzymewith Mps" In Complex Treatment Of Chronic Diseases Of Digestive System]. Modern gastroenterology, Modern Gastroenterology 2005;5 (25):66-8.
Beryozov V, Rudenko N, Nechipurenko T, Dorofeev A, Tomash O, Andrienko I, et al. The Possibilities of The Differentiated Approach to Treatment of Patients with Meteorism, Possibilities of the differential approach to treatment of patients with meteorism. Modern gastroenterology, Modern Gastroenterology. 2005;3(23):76-7.
Ran Z, Yuan Y, Li Z. The efficacy of Combizym in the treatment of Chinese patients with dyspepsia: a multicenter, randomized, placebo-controlled and cross-over study. J Dig Dis. 2009;10(1):41-8.