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J Dig Dis. 2018 Aug 13. doi: 10.1111/1751-2980.12655. [Epub ahead of print]

Enzyme therapy for functional bowel disease-like post-prandial distress.

Author information

1
Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas.
2
Baylor College of Medicine, Houston, Texas.
3
Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
4
Department of Internal Medicine, Meritus Medical Center, Hagerstown, Maryland.

Abstract

Post-prandial gastrointestinal symptoms such as diarrhea, abdominal distension, flatulence, bloating and a feeling of fullness are common complaints of often unknown etiology and pathogenesis. There is a long history of trials reporting the successful use of products containing a variety of combinations of digestive enzymes including a number of randomized placebo-controlled trials. We provide a narrative review of studies describing the use of multi-digestive enzymes for symptoms consistent with irritable bowel syndrome. We describe clinical trials reported over the past 60 years including double-blinded randomized, placebo-controlled studies and recent trials that focused on post-prandial diarrhea consistent with diarrhea-predominant irritable bowel syndrome. Disaccharidase deficiencies or deficiencies of other carbohydrate digesting enzymes were excluded. Worldwide studies have generally reported success with multi-enzyme preparations although none used a factorial design to identify subgroups or attempted to link specific symptom responses to specific components of therapy. Although there is a long history of the successful use of multi-enzyme preparations for post-prandial symptoms consistent with irritable bowel syndrome, long-term studies using validated scoring systems and factorial designs are needed to confirm the results for specific symptoms and the components of the combination drugs received.

KEYWORDS:

diarrhea; digestive enzyme; fecal elastase-1; irritable bowel syndrome; post-prandial distress; therapy

PMID:
30101562
DOI:
10.1111/1751-2980.12655

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