The process of digestion and the absorption of nutrients from food is due to the fact that pancreatic enzymes enter the small intestine. Moreover, this body is responsible for metabolic and conversion processes, controls blood sugar levels, secretes hormonal compounds involved in the regulation of biochemical mechanisms.
What enzymes does the pancreas produce?
There are the following types of substances:
1. Nucleases - cleave nucleic acids (DNA and RNA), which are the basis of any incoming food.
- elastase - designed to break down dense proteins and elastin,
- trypsin and chymotrypsin are similar to gastric pepsin, are responsible for the digestion of dietary proteins,
- carboxypeptidase - acts together with the above types of protease, but has other mechanisms for cleavage.
3. Amylase - is allocated for the correction of carbohydrate metabolism, the digestion of glycogen and starch.
4. Steapsin - splits fatty compounds.
5. Lipase - affects a special type of fat (triglycerides), which are pretreated with bile produced by the liver into the intestinal lumen.
Pancreatic Enzyme Assay
For the diagnosis of diseases of the organ in question, 3 laboratory tests are used:
- blood chemistry,
- Analysis of urine,
- serum analysis.
An important role is played by the quantitative determination (activity) of amylase, elastase and lipase.
Symptoms of deficiency and excess pancreatic enzymes
One of the first clinical manifestations of the first pathology is a change in the consistency of the stool (it becomes liquid), since the failure to produce lipase occurs first.
Other symptoms of pancreatic enzyme deficiency:
- reduced physical activity
- decreased appetite and body weight
- abdominal pain,
- weakness, drowsiness,
- constantly recurrent vomiting.
The second disease is called pancreatitis and is often triggered by excessive production of amylase and lipase. Interestingly, the signs of the disease are similar to the deficiency of enzymes, an additional symptom can be considered a slight increase in body temperature.
How to restore pancreatic enzymes?
To normalize the functioning of the body with insufficient production of the described substances, substitution drug therapy is used in combination with a therapeutic (sparing) diet.
Pancreatic Enzymes Tablets:
- Mezim Forte,
- Kotazim Forte,
There are also many analogues and generics of the listed drugs containing either 1-2 types of chemical compounds, or their combined complex.
With pancreatitis, in the first place, a strict diet is prescribed, including fasting for 1-3 days. After that, pancreatic enzyme inhibitors are used:
- aminocaproic acid,
Simultaneously with taking pills, it is important to continue to follow the rules for the construction of the diet - only low-fat food, preferably without meat, mucous porridge and soups. Additionally, it is recommended to use a large amount of alkaline mineral water, about 2 liters per day.
What role do pancreatic enzymes play?
The pancreas belongs simultaneously to two systems of the human body: endocrine and digestive, therefore its working functions operate with double load.
The first function is the production of pancreatic enzymes, which are instantly released into the duodenum, where the following substances are immediately split, coming with a new batch of food: fats, proteins, carbohydrates.
The second duty is responsible for the endocrine system, while beta cells are responsible for producing insulin hormone in the human body. In turn, insulin feeds the body with glucose, which is also important for the proper metabolism of carbohydrates, fats and proteins.
The secreted prostate juice contains the following substances:
If their number is below the norm, then the proper functioning of the digestive system is disturbed. Every day, the pancreas synthesizes about 1 liter of pancreatic fluid (juice), in which there are about twenty different enzymes, and the stability of the process of digesting food depends on them.
What enzymes the pancreas secretes? It should be said that the pancreas produces a number of enzymes.
Substances belonging to the proteolytic group that are actively involved in the processing of protein:
Substances responsible for the processing of carbohydrates:
Substances that break down fat:
As soon as an acute lack of pancreatic enzymes is formed, the activity of the digestive system is significantly disturbed, which entails a whole series of negative phenomena that do not affect health in the best way. In this situation, there is a dramatic change in stool and an extremely low lipase index.
How to recognize their lack in time?
Symptoms of pancreatic enzyme insufficiency are manifested by the following abnormal phenomena:
- Severe pain, which is localized in the left hypochondrium and in the entire epigastric region.
- Heaviness in the stomach.
- Nausea, which can be extremely debilitating.
- Vomiting and severe vomiting with a bitter taste in the mouth (release of bile).
- Constipation or diarrhea.
- Increased gas formation.
- Unreasonably fast weight loss.
- Decreased performance.
- Great fatigue.
Any of these symptoms present is an alarm bell, requiring immediate attention to a gastroenterologist, who should schedule appropriate tests, as well as the necessary examination of the pancreas and the entire gastrointestinal tract.
Symptoms of deficiency and overabundance of enzyme production
For normal food digestion it is necessary to have enough enzymes in the produced pancreatic juice. Identified several pathologies associated with insufficient synthesis of enzymes. According to the mechanism of development, they belong to food intolerance.
Enzyme deficiency can occur at birth or be acquired. The first variant develops as a result of gene breakdowns, in the second case the development of pathology occurs against the background of changes in the pancreatic parenchyma.
The reasons leading to the acquired deficiency in the production of enzymes may be different, sometimes not depending on the state of the gland, but are associated with external influences or changes in the internal organs. In the first place is any pathology of the pancreas, but the factor of violations can be:
- any serious diseases of human organs and systems,
- unfavorable ecological situation
- hypovitaminosis and micronutrient deficiencies, as well as protein deficiency in nutrition,
- drug intoxication,
- infectious diseases,
- violation of intestinal microflora.
All the various reasons that sometimes cause severe changes in enzyme activity have common clinical manifestations. The degree of their severity depends on the severity of the underlying disease or the intensity of the influencing factor:
- reduced appetite
- flatulence (bloating) of varying degrees, air burping,
- nausea and vomiting, in severe cases - repeated, not bringing relief,
- drastic weight loss - sometimes against the background of normal nutrition,
- children have a delay in physical development.
Such symptoms are peculiar to both congenital and acquired enzyme deficiency. In the case of gene pathology, it can manifest itself from the first days of birth and is recognized by common symptoms: lethargy, baby’s tearfulness, anxiety, regurgitation after eating, frequent smelly loose stools up to 8 or more times a day. The type of a chair is characteristic: foamy, plentiful, with a sharp sour smell. This usually indicates a violation of carbohydrate metabolism and enzymes associated with it.
The condition and clinical manifestations resemble an intestinal infection, therefore a number of diagnostic tests are carried out to clarify the diagnosis. The survey reveals the lack of a particular enzyme is experiencing the body.
Today, several pathologies associated with a small number of synthesized enzymes of the pancreas were studied:
- Lactase deficiency.
- Celiac disease - a violation of the splitting of gluten.
- Phenylketonuria is an amino acid deficiency.
Insufficient lactase production
Lack of lactase production - an enzyme that breaks down milk sugar (lactose), manifests itself from the first days of a child's life. Iron cannot secrete lactase. The complete absence of this enzyme or a sharp decrease in its release into the cavity of the small intestine can block the breakdown of lactose. It is not absorbed in its original form and is not absorbed by the body. This is manifested by increased appetite. But the child remains hungry due to lack of saturability: lactose is not digested, does not break down in the intestine and is not absorbed.
On examination, pronounced abdominal distention, pain on palpation, frequent belching with air, regurgitation with milk after feeding are detected. Frequent green stools with an unpleasant odor may continue every 2–3 hours. Expressed constant crying, moodiness, poor sleep.
It manifests itself in a child when the feeding of cereals begins. The development of pathology is associated with the impossibility of the pancreas to produce a proteolytic enzyme that breaks down the protein gliadin. It is found in all grains, with the exception of rice, corn, buckwheat. The stomach and intestines do not digest protein.
Late diagnosis and the lack of timely treatment can cause the death of the patient. Under the influence of gliadin in such people atrophy of intestinal mucous cells occurs with impaired absorption of proteins, carbohydrates, fats, vitamins, minerals. Develop severe water and electrolyte disorders and malnutrition. This is accompanied by polyfecalia, flatulence, psychomotor retardation.
Phenylketonuria is a manifestation of insufficiency of the pancreatic enzyme that cleaves phenylalanine (one of the amino acids of the protein) and turns it into tyrosine. The latter prevents the deposition of fat, reduces appetite, improves the function of other endocrine apparatus - the pituitary, thyroid, adrenal glands. Accumulating products of phenylalanine hydrolysis accumulated in the body, toxic to the cells of the nervous system. From the first days of life, indomitable vomiting occurs immediately after feeding. It resembles pylorospasm or stenosis of the duodenal bulb. Specific is increased sweating with a mouse smell of sweat and urine, are also concerned:
- constant weakness
- reduction in head size
- skin changes.
The condition worsens further: there is a lag in physical and mental development - the child begins to sit, walk and talk late (60% of children with such pathology develop an idiocy by the age of 3-4 years - a complete lack of thinking and speech).
The main and only method for the treatment of these congenital disorders of the pancreas at the moment is diet. Sometimes (with lactase deficiency) lactase intake is prescribed.
Excess enzyme production occurs with pancreatitis. Clinical manifestations are similar to symptoms of insufficient pancreatic secretion: abdominal pain, frequent loose stools, nausea, repeated vomiting without relief, flatulence. The severity of each symptom depends on the extent of damage to the parenchyma of the pancreas. In severe cases, not only the exocrine function of the gland is impaired, but also the increcretory: the inflammatory process affects the islets of Langerhans - structures that synthesize hormones. If beta cells producing insulin die, the process of carbohydrate metabolism is suppressed with the development of diabetes.
Pathology diagnostic methods
To diagnose the functional state of the pancreas used biochemical and instrumental methods of research.
In addition, liver functions - bilirubin, transaminases, total protein and its fractions, blood glucose - are determined.
In the urine detect the presence of amino acids.
To identify phenylketonuria - congenital pathology of the pancreas - the definition of phenylalanine in the blood is used. These tests are carried out in maternity homes for all newborns on the 4–5th day of life. According to WHO recommendations, pathology is included in the list of hereditary diseases recommended for early diagnosis.
Celiac disease is detected by methods of serological diagnosis with the determination of antibodies and antigens with gluten intolerance.
Lactase deficiency is confirmed by the results of blood tests and analysis of the lactose curve: lactose is stimulated - the patient is given lactose in a small dosage, then blood is examined. And also determined the level of lactose in the urine, where it goes in small quantities.
Instrumental research methods are used to diagnose and exclude organic lesion of pancreatic tissue or the presence of stones, cysts, inflammatory processes. Are held:
What tests need to pass to determine the enzymes?
We study blood and urine for the activity of the main enzymes:
Coprogram in the presence of undigested muscle fibers, fats, starch particles indicates insufficient enzyme content.
The main indicator in the study analysis of feces - elastase. Its reduction can help cure the disease and make the digestive organs function normally.
Drug treatment of pathologies
In chronic pancreatitis, when the process is due to insufficient intake of enzymes (as opposed to acute, with the development of pancreatic necrosis), the main method of treatment is enzyme replacement therapy. Enzyme preparation is prescribed, which normalizes the functioning of internal organs. At the same time, a diet is needed, which must be followed for a long time, sometimes for life, it depends on the degree of enzyme deficiency.
Correction of exocrine insufficiency is carried out on the level of lipase - an indispensable enzyme that is produced in full by the pancreas itself. Therefore, the activity of the drug, which is selected for substitution therapy, is calculated in lipase units - LU. In the annotation to any of them these data are indicated - the amount of lipase in LU. The list of enzymes for the correction of digestion is extensive. Dose, frequency and duration of treatment is prescribed and monitored by a doctor and depends on the degree of deficiency.
Today, the most effective is CREON - double-shell drug. Its production uses innovative technologies: one capsule contains a large number of enteric microspheres containing the enzyme.This improves the absorption of the enzyme: it is not susceptible to the destruction of hydrochloric acid in the stomach, since it does not act on the capsule. The output of the enzyme from the microspheres and their digestion of food occurs in the lumen of the duodenum. Its use is convenient in three existing dosages: 10,000, 25,000 and 40,000 IU of lipase.
The drug can be prescribed to a child and an adult patient with severe pancreatitis, when high doses of the drug are needed.
In parallel, symptomatic treatment is prescribed, which consists in taking antispasmodics, painkillers, drugs that reduce the secretion of gastric hydrochloric acid by the stomach, and the formation of gas in the intestine. Therapy can be carried out on an outpatient basis at home, but under the supervision of a specialist.
Causes of enzyme deficiency
The provoking factors of the abnormal process in the pancreas, which significantly inhibit the production of enzymes, are:
- Excessive passion for alcohol.
- Damage to the cells of the pancreas due to the intake of certain medications.
- Improper nutrition and overeating.
- Damage to the duct of the pancreas.
- Crohn's disease.
- Lack of protein
- Unsystematic meal.
- Excessive amount of animal fats in consumed food.
- Modifications of pancreatic tissue.
- Reduction or blockage of the ducts.
- Edema of the body.
Diagnosis of enzyme deficiency and features of therapy
To clarify the number of enzymes produced by the pancreas, the following methods are used:
- Determination of glucose index. This analysis of the study of pancreatic enzymes helps to clarify the excess or deficiency of insulin produced by the pancreas.
- Blood chemistry.
- General blood analysis.
- Refinement of amylase in the blood.
- Urine analysis for the presence of enzymes.
- A clinical study of the feces helps to establish the presence of undigested fat in the stool, as well as starch grains, which indicates a lack of certain enzymes responsible for the digestion of carbohydrates. In addition, this laboratory fence also shows the presence or absence of muscle fibers related to enzymes responsible for the digestion of protein foods.
- Ultrasound of the pancreas.
- CT (computed tomography).
- MRI (magnetic resonance imaging).
If the diagnosis is confirmed: “enzymatic pancreatic insufficiency,” it is important to adhere to a healthy diet, that is, a diet that a nutritionist or a gastroenterologist will sign out.
The dietary table is an important therapeutic measure in the event of a deficiency of enzymes, therefore its careful observance speeds up the moment of recovery:
- Eat small meals and often.
- Meal frequency - at least 5-7 times a day.
- Priority is given to plant foods that are easily absorbed by the body and do not make it difficult for the digestion process.
- In the diet must certainly be present soups.
In the diet menu should be food rich in plant enzymes, for example:
- Garlic and horseradish.
- Soy sauce.
- Cabbage, especially cauliflower and white.
Pancreatic deficiency therapy is aimed at restoring all of the working responsibilities of the pancreas.
During treatment, patients should not forget about the absolute cessation of smoking and alcoholic beverages, as well as a number of foods: smoked foods, fried, sour and spicy dishes, pickles and carbonated drinks.
Also an important role in replenishing the enzymatic deficiency is played by drugs, which will be discussed below.
Preparations for the restoration of enzymes
Many patients ask which enzymes are best for pancreatitis? It should be said that it is impossible to buy such funds at a pharmacy in any case; this is dangerous for serious consequences. Only a specialist can correctly choose the best medicine option, taking into account the results of the examination and analyzes.
Drugs aimed at normalizing the production process of pancreatic enzymes are divided into two main types:
Therapeutic effects of the first focused on replenishing the human body with the missing enzymes. The following drugs have proven themselves:
It is made from the pancreas of a pig and a bull. It contains important substances - trypsin and amylase. The drug is prescribed if the patient has the following abnormalities in the body:
- Weak acidity of gastric juice.
- Hypofunction of the pancreas and liver.
- Other abnormalities in the digestive system.
The preparation contains: amylase, lipase, protease and substances of bile. The tool has a good drug effect:
- Improves the digestive process.
- Eliminates unpleasant stomach discomfort.
This medicine contains many amylolytic and proteolytic enzymes.
This group of drugs eliminates the excess enzymes, if it was confirmed by the results of surveys:
- Panthripin. Suppresses excessive revival of proteolytic enzymes. When treating with this remedy, it is necessary to periodically check the amylase index in the composition of urine or blood.
- Aprotinin. It is a polypeptide medication that reduces the exorbitant energy of trypsin, plasmin and other organ enzymes.
In addition, therapy with these drugs is carried out only under medical supervision and with periodic testing, which help monitor the dynamics of the disease and adjust the treatment process.
Features and release form of enzyme products
Modern pharmacy offers a sufficient choice of enzyme drugs in various forms:
The raw material for their manufacture is the pancreas of pigs and bulls, which is subjected to drying with further processing into pancreatin.
You should also pay attention to an important nuance in the treatment of these means: the greatest drug activity of such drugs is observed during the meal.
At the same time, pancreatic enzymes in tablets, dragees, and so on, are necessarily enclosed in a special coating, designed to reliably protect the active components from elevated temperature and direct contact with the gastric environment, which provokes their premature decay.
As you can see, pancreatic juice enzymes are important components of the entire digestive system. Their production is engaged in the pancreas, but in the event of some kind of failure in this process, their production drops significantly, which leads to the development of a number of pathologies.
That is why it is so important, in case of susceptibility to a deficiency of pancreatic enzymes, to periodically conduct an examination of the pancreas and, if necessary, to take appropriate therapeutic measures in a timely manner.
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