Enzyme therapy of maldigestion (a review)

Abstract

Enzyme substitution therapy of intestinal maldigestion is the main field of medical applications of the enzyme drugs. There is a broad spectrum of notions concerning the efficacy and rational compositions of these drugs and the effects of their various medication forms on the functions of organs of the digestive system. These problems have been analyzed in a number of review publications [1 -4].The main indication for the use of enzyme drugs is a pronounced insufficiency of the pancreatic secretion observed in the cases of chronic pancreatitis, pancreatic cancer, and cystic fibrosis [1, 2, 5-7]. Most of the researchers agree in that steatorrhea, as the most serious sign of pancreatic insufficiency, appears following a decrease in the enzyme secretion to 5 -10% of the maximum pancreatic secretion level [1]. However, patients having such a pronounced pancreatic insufficiency are comparatively rare, representing for the most part the group of chronic pancreatitis with alcoholic etiology. The therapy of such cases involves administration of a high dose of enzyme preparations aimed at the elimination ofsteatorrhea, diarrhea and other signs of dyspepsia [5, 6, 8 -10].The use of enzyme preparations in the case of acute pancreatitis is inexpedient. This was proved by investigations of the exocrine function in patients 72 h after the onset of disorder, showing that the level of pancreatic protease and amylase secretion and the pH value in the duodenum were the same as in the healthy human organism [11]. However, some evidence obtained on the models of acute pancreatitis suggests that the exocrine function of pancreas is disturbed already in the early stage of this disease [12,13].Pharmaceutical companies recommend using the enzyme preparations for the treatment of digestive tract disorders of many types [14][15][16]. Gastroenterologists believe that the use of enzyme preparations is justified, besides the cases ofhypot St. Petersburg Pediatric Medicinal Academy, St. Petersburg, Russia.