Pancreatic enzymes: when to take

Pancreatic enzymes: when to take

Chapter 1: Pancreas and its role in digestion

1. 1 Anatomy and physiology of the pancreas

   The pancreas (Pancreas) is an important organ of the digestive system located in the abdominal cavity behind the stomach. It performs two main functions: exocrine and endocrine.

   • Exocrine function: This function is associated with the production and secretion of digestive enzymes, which are necessary for the splitting of proteins, fats and carbohydrates in the small intestine. The pancreas containing these enzymes is released through the pancreatic duct into the duodenum, where it is mixed with bile and food coming from the stomach.

   • Endocrine function: This function is associated with the production of hormones, such as insulin and glucagon, which regulate blood sugar. These hormones are produced in special cells called the islands of Langerganes, and are released directly into the bloodstream.

   In this article, the main attention is paid to the exocrine function of the pancreas and the use of enzyme preparations to compensate for its failure.

2. 2 Digestive enzymes produced by the pancreas

   The pancreas produces a wide range of digestive enzymes, each of which plays a certain role in the breakdown of various components of food. The main enzymes include:

   • Amylase: Cloths starch and other complex carbohydrates into simpler sugars, such as glucose and maltose.

   • Lipase: It breaks down fats into glycerin and fatty acids. Lipase is a key enzyme for digestion of fats, and its failure can lead to violation of the absorption of fats and fat -soluble vitamins.

   • Proteases (trippsin, chimotrypsin, carboxypeptidase): The proteins are split into peptides and amino acids. These enzymes are secreted in an inactive form (professional) and are activated in the small intestine to prevent the pancreatic self -digesting.

   • Nuclezy (Ribonucleaza and deoxyribonucleaz): Nucleic acids (DNA and RNA) are split into nucleotides.

   These enzymes work together to ensure effective digestion of food and absorption of nutrients.

3. 3 Digestive process involving the pancreas

   The digestion process involving the pancreas can be represented as follows:

   1. Food in the stomach: Food entered in the stomach is mixed with gastric juice containing hydrochloric acid and pepsin, which begins to split proteins.

   2. The transition of food to the duodenum: Partially digested food (Himus) gradually enters the stomach to the duodenum.

   3. Stimulation of the secretion of pancreatic juice: The receipt of the chimus into the duodenum stimulates the release of hormones, such as secretin and cholecystokinin (CCC), which, in turn, stimulate the pancreas to the production and secretion of pancreas.

   4. Planting nutrients: The pancreas containing digestive enzymes is mixed with the chimus in the duodenum. Enzymes break down carbohydrates, fats and proteins into simpler components that can be absorbed in the small intestine.

   5. Nutritional absorption: The products of the splitting of nutrients (glucose, amino acids, fatty acids, glycerin) are absorbed through the wall of the small intestine into the blood and lymph and transported to the body cells for use as energy and building materials.

4. 4 Pancreatic function disorders (exocrine deficiency)

   Exocrine pancreatic failure (Enpzh) is a condition in which the pancreas does not produce a sufficient number of digestive enzymes for normal digestion of food. This can lead to various symptoms, such as:

   • Steatorrhea: The presence of an excess amount of fat in the feces, which manifests itself in the form of a fat, fetid stool, which is difficult to wash off.

   • Diarrhea: Frequent, liquid chair.

   • Stomach ache: Discomfort or pain in the upper abdomen.

   • Bloating and flatulence: Excessive formation of gases in the intestines.

   • Weight loss: Insufficient absorption of nutrients can lead to weight loss.

   • Deficiency of fat -soluble vitamins (A, D, E, K): Violation of fat absorption leads to a deficiency of these vitamins.

   Enpzh can be caused by various factors, including chronic pancreatitis, cystic fibrosis, pancreatic cancer, pancreatic or stomach surgery, as well as some other diseases.

Chapter 2: Enzymes for the pancreas

1. 1 Types of enzyme preparations

   Enzyme drugs used to treat ennps contain a mixture of digestive enzymes, mainly lipase, amylase and proteases. They are available in various forms, including:

   • Powders: They contain enzymes in powder form, which must be mixed with food or water before consumption.

   • Capsules: They contain enzymes in capsules that need to be swallowed entirely. Some capsules contain minimicrospheres or microwaves covered with an intestinal shell that protects enzymes from destruction in the acidic medium of the stomach.

   • Tablets: They contain enzymes in a tablet form, which can also be covered with an intestinal shell.

   The most effective preparations containing minimicrospheres or microwaves with an intestinal shell, as they provide optimal enzyme delivery to the duodenum, where they are most active.

2. 2 The composition of enzyme preparations (lipase, amylase, proteases)

   The main component of enzyme preparations is lipase, as it plays a key role in the digestion of fats, and its deficiency most often leads to steatore. The lipase content in the drug is usually indicated in units of activity (units pht. Eur. Or USP). The recommended dose of lipase depends on the degree of ENPZH and the amount of fat consumed with food.

   Amilase and proteases are also important for digesting carbohydrates and proteins, but their deficiency is usually less pronounced than lipase deficiency. Therefore, the content of amylase and protease in enzyme preparations is usually lower than the lipase content.

   Some enzyme preparations may also contain other components such as bile acids or vitamins.

3. 3 The mechanism of action of enzyme preparations

   Enzyme drugs act by replacing the missing digestive enzymes of the pancreas. When taking food, the enzymes contained in the drug are mixed with the chimus in the duodenum and help to split carbohydrates, fats and proteins into simpler components that can be absorbed in the small intestine.

   The intestinal shell covering minimicrospheres or microwaves protects enzymes from destruction in the acidic medium of the stomach. The shell dissolves only in the alkaline medium of the small intestine, releasing enzymes at the place of their greatest activity.

4. 4 Enzymes selection criteria

   When choosing an enzyme preparation, several factors must be taken into account:

   • Lipase content: Choose a drug with a sufficient lipase content corresponding to the degree of ENPZH and the amount of fat consumed with food.

   • Output form: Preparations in the form of minimicrosphere or micro -tank with an intestinal shell provide optimal enzyme delivery to the small intestine.

   • Tolerance: Some people may experience side effects of enzyme preparations, such as nausea, vomiting, diarrhea or abdominal pain. In this case, it is necessary to consult a doctor to adjust the dose or choose another drug.

   • Price: Enzymes can be quite expensive, so when choosing the drug, it is necessary to take into account its cost.

   It is important to consult a doctor or nutritionist to choose the most suitable enzyme drug and determine the optimal dose.

5. 5 Side effects and contraindications

   Enzyme drugs are usually well tolerated, but in some cases side effects can cause side effects, such as:

   • Nausea and vomiting
   • Diarrhea or constipation
   • Stomach ache
   • Allergic reactions (rarely)

   In very rare cases, when taking high doses of enzyme preparations, fibrosing colonopathy (narrowing of the colon) may develop.

   Contraindications to the use of enzyme preparations are:

   • Acute pancreatitis
   • Individual intolerance to the components of the drug

   When any side effects appear, it is necessary to stop taking the drug and consult a doctor.

Chapter 3: When to take enzymes for the pancreas

1. 1 Diagnosis of exocrine pancreatic insufficiency

   Before starting to take enzyme preparations, it is necessary to establish the diagnosis of ENPG. There are various diagnostic methods of the Enpzh, including:

   • Calais analysis for elastasis-1: This test measures the concentration of elastase-1 (enzyme produced by the pancreas) in feces. Low level of elastasis-1 indicates an Enpzh.

   • Quantitative determination of fat in feces (test van de camera): This test measures the amount of fat secreted with feces within 72 hours. An increased amount of fat in the feces indicates a violation of the absorption of fats, which may be associated with the Enpzh.

   • Direct tests of the functions of the pancreas (stimulation tests): These tests measure the ability of the pancreas to produce and secrete digestive enzymes in response to stimulation.

   • Visualizing methods (CT, MRI, ultrasound): These methods can be used to evaluate the structure of the pancreas and detect diseases that can cause ENPH.

   The diagnosis of the Enpzh should be established by the doctor on the basis of the results of the examination and the clinical picture.

2. 2 Indications for taking enzyme preparations

   Enzyme drugs are prescribed in the presence of an ENPG caused by various diseases, such as:

   • Chronic pancreatitis: The most common reason is the Enpzh.
   • Cystic fibrosis (cystic fibrosis): A genetic disease affecting the respiratory and digestion organs, including the pancreas.
   • Pancreatic cancer: The tumor that can disrupt the function of the pancreas.
   • Pancreatic operations or stomach: Requid part of the pancreas or stomach can lead to enpzh.
   • Schwahman-Daimond syndrome: A rare genetic disease characterized by pancreatic failure and other health problems.
   • Celiacia: Autoimmune disease, in which glutenic use leads to damage to the mucous membrane of the small intestine and impaired absorption of nutrients, which can aggravate the Enpzh.

   The doctor may prescribe enzyme drugs in the presence of symptoms of the ENPG and a confirmed diagnosis.

3. 3 Recommendations for taking enzyme preparations

   • Reception time: Enzymes should be taken immediately before meals or during food. This allows the enzymes to mix with food in the stomach and duodenum and begin to split it. If you take a few capsules, you can divide the dose and take part before meals, and part – during meals.

   • Dosage: The dose of enzyme preparations is selected individually depending on the degree of ENPH, the amount of fat consumed with food, and an individual reaction to the drug. They usually start with a low dose and gradually increase it until the optimal effect is achieved. It is important to follow the recommendations of a doctor on dosage.

   • Meeting with food: Enzymes should be taken with each meal containing fats. It is especially important to take enzymes with large meals and food containing a lot of fat.

   • Output form: Capsules or tablets with an intestinal shell should be swallowed entirely, without chewing or opening. This is necessary to protect enzymes from destruction in the acidic environment of the stomach.

   • Related drugs: Some drugs, such as antacids (reducing the acidity of the stomach), can reduce the effectiveness of enzyme preparations. If you take antacids, consult your doctor about how to take enzyme drugs correctly.

   • Regular monitoring: During the use of enzyme preparations, it is necessary to regularly be observed in the doctor and control the symptoms of the ENPH, as well as analyzes to evaluate the effectiveness of treatment.

4. 4 Determination of the optimal dose of enzyme preparations

   The optimal dose of enzyme preparations is a dose that allows you to effectively control the symptoms of the Enpzh, such as steator, diarrhea, abdominal pain and weight loss, and provides sufficient absorption of nutrients.

   Determining the optimal dose is an individual process that requires cooperation between the patient and the doctor. Usually start with a low dose and gradually increase it until the following goals are achieved:

   • Reducing or disappearance of steatore: Normalization of the consistency and smell of feces.

   • Improving fat absorption: Normalization of the level of fat -soluble vitamins in the blood.

   • Reducing or disappearance of other symptoms of ENPGA: Reducing diarrhea, abdominal pain, bloating and flatulence.

   • Set or maintenance of weight: Improving the general state of health.

   The dose of enzyme preparations can be adjusted depending on the content of fat in food. If you plan to eat food containing a lot of fat, you may need to increase the dose of enzymes.

   It is important to keep a diet and symptoms to track the effect of taking enzyme drugs and report any changes to the doctor.

5. 5 Diet with exocrine pancreatic failure

   In addition to taking enzyme preparations, a diet plays an important role in the treatment of ENPG. General diet recommendations for enpla include:

   • Fat consumption restriction: Reducing fat consumption can help reduce steator and other symptoms of the Enpzh. It is recommended to limit fat intake up to 30-40 grams per day.

   • Frequent and small meals: Separation of food into several small techniques can facilitate the digestion and absorption of nutrients.

   • Exception of alcohol: Alcohol can aggravate inflammation of the pancreas and worsen the Enpzh.

   • Easily digestible products: The use of easily digestible products, such as boiled or stewed vegetables, low -fat meat and fish, can facilitate the functioning of the pancreas.

   • Sufficient fluid consumption: The use of a sufficient amount of fluid helps to prevent dehydration, which can be caused by diarrhea.

   • Vitamins and mineral additives: With an ENPH, the absorption of vitamins and minerals, especially fat -soluble vitamins (A, D, E, K) may be violated. The doctor may recommend taking the additives of vitamins and minerals.

   It is important to consult a nutritionist to develop an individual food plan that takes into account your needs and preferences.

Chapter 4: Alternative approaches and additional treatment methods

1. 1 Additional enzymes and probiotics

   In addition to standard enzyme preparations containing lipase, amylase and proteases, some people with ENPH can benefit from taking additional enzymes, such as:

   • Bromelain: The enzyme contained in pineapples, which has anti -inflammatory properties and can help in the digestion of proteins.
   • Papain: The enzyme contained in the papaya, which can also help in the digestion of proteins.
   • Lactase: An enzyme that helps to digest lactose (milk sugar). Lactase can be useful for people with lactose intolerance, which also have an enpzh.

   Probiotics are living microorganisms that benefit intestinal health. Some studies show that probiotics can improve digestion and reduce the symptoms of the Enpzh, such as diarrhea and bloating. However, additional studies are needed to confirm these results.

   Before taking additional enzymes or probiotics, you need to consult a doctor.

2. 2 Vitamins and minerals

   With an ENPH, the absorption of vitamins and minerals, especially fat -soluble vitamins (A, D, E, K) may be violated. The deficiency of these vitamins can lead to various health problems, such as:

   • Vitamin A deficiency: Visual impairment, dry skin, increased susceptibility to infections.
   • Vitamin D deficiency: Bone weakness, increased risk of fractures, impaired immune function.
   • Vitamin deficiency is: Nervous disorders, muscle weakness.
   • Vitamin K deficiency: Violation of blood coagulation, increased risk of bleeding.

   The doctor may recommend taking the additives of vitamins and minerals to replenish the deficit. It is important to follow the recommendations of the doctor on dosage and the duration of the reception of additives.

3. 3 Control over the underlying disease

   Enpzh treatment should be aimed not only at the relief of symptoms, but also to control over the underlying disease that causes Enpzh. For example, in chronic pancreatitis, it is important to observe a diet, exclude alcohol and smoking, as well as take medications that reduce inflammation. With cystic fibrosis, it is necessary to carry out regular physiotherapeutic procedures and take medications that thin the mucus.

   Control over the underlying disease can help slow down the progression of the ENPG and improve the general health.

4. 4 New methods of treatment

   Currently, studies of new methods of treating ennpzh are conducted, such as:

   • Pancreatic transplantation: The transplantation of the donor pancreas can be an effective method of treating severe ennges, especially in patients with diabetes.
   • Gene therapy: This treatment method is aimed at correcting genetic defects that cause cystic fibrosis and other pancreatic diseases.
   • Stem cells: Studies show that stem cells can be used to restore damaged pancreatic tissue.

   These new methods of treatment are at the development stage and are still inaccessible to wide use.

Chapter 5: Life with exocrine pancreatic failure

1. 1 Adaptation to diet and lifestyle

   Life with Enpge requires adaptation to a diet and lifestyle. It is important to observe a low -fat diet, often with small meals, exclude alcohol and smoking, as well as take enzyme preparations regularly.

   Some people with Enpzh may experience difficulties in compliance with the diet and taking enzyme drugs. In this case, it can be useful to seek help from a nutritionist or psychologist.

   It is important to remember that enpzh is a chronic disease that requires constant attention and care. However, with the proper treatment and compliance with the doctor’s recommendations, you can lead a full and active life.

2. 2 Psychological aspects

   Life with a chronic disease, such as Enpzh, can influence the psychological state of a person. Some people may feel anxiety, depression or a sense of social isolation.

   It is important to seek help from a psychologist or psychotherapist if you experience psychological difficulties. Psychological support can help cope with anxiety, depression and other emotional problems associated with Enpzh.

3. 3 Support and resources

   There are various organizations and resources that can provide support to people with Enpzh and their families. These organizations can provide information about the disease, tips on treatment and diet, as well as the possibility of communicating with other people living with Enpzh.

   Some useful resources include:

   • National Pancreas Foundation National Fund: Provides information about pancreatic diseases, including ENPH, and also supports research and provides support to patients and their families.
   • Cystic Fibrosis Foundation Foundation: Provides information and support to people with cystic fibrosis, including those who have an Enpzh.
   • American Association of Liver Association (American Association for the Study of Liver Diseases): Provides information on liver and pancreatic diseases, and also supports research and provides support to doctors and patients.

4. 4 Future research and development

   Currently, active studies in the field of ENPGs aimed at developing new diagnostic and treatment methods are being conducted. These studies include the study of new enzyme preparations, gene therapy and stem cells.

   Future research and development can lead to more effective methods of treating ennPzh and improving the quality of life of people living with this disease.

5. 5 The importance of early diagnosis and treatment

   Early diagnosis and treatment of ENPG are crucial to prevent complications and improve the quality of life. If you have symptoms of Enpzh, such as steator, diarrhea, abdominal pain and weight loss, consult a doctor for examination.

   The early start of treatment with enzyme preparations and compliance with the doctor’s recommendations by diet and lifestyle can help control the symptoms of the Enpzh and prevent the development of complications.