Enzyme therapy for functional bowel disease‐like post‐prandial distress

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.

Harnessing the Potential of Enzymes as Inhaled Therapeutics in Respiratory Tract Diseases: A Review of the Literature

“…Additionally, ERT uses the action of exogenously produced enzymes to compensate for a deficit of a specific enzyme in the case of genetic disorders or where required as a result of complications from other conditions. Examples where ERT is considered a first-line treatment option are lysosomal storage diseases, exocrine pancreatic insufficiency [ 9 ], and irritable bowel syndrome [ 38 , 39 , 40 ]. The supplementation of native enzymes is also used in the treatment of RTIs.…”

Biomolecules from Plant Wastes Potentially Relevant in the Management of Irritable Bowel Syndrome and Co-Occurring Symptomatology

“…Digestive enzyme supplementation is a current treatment for gastrointestinal symptoms of IBS based on the administration of digestive enzymes in different formulations to facilitate or modulate digestion and intestinal motility in IBS patients [106,107]. In this way, Spagnuolo et al [108] showed that digestive enzyme supplementation alongside beta-glucan and inositol could lead to significant improvements in abdominal pain, bloating, and flatulence.…”

“…In this way, Spagnuolo et al [108] showed that digestive enzyme supplementation alongside beta-glucan and inositol could lead to significant improvements in abdominal pain, bloating, and flatulence. Similarly, Graham et al [107] suggested the oral administration of digestive enzymes and modulators such as protease, amylase, pancreatin, bile salts, betaine hydrochloride, hemicellulase, and cellulase could provide significant benefits in the management of functional digestive disorders. Furthermore, the administration of pancreatic enzymes in diarrhea-predominant IBS patients significantly improved stool consistency and abdominal pain.…”

“…Furthermore, the administration of pancreatic enzymes in diarrhea-predominant IBS patients significantly improved stool consistency and abdominal pain. At the same time, the authors thoroughly documented possible pancreatic insufficiency in diarrhea-predominant IBS [107]. The best-known example is Carica papaya fruit peel extract, of which the principal constituent, papain, is considered relevant in alleviating digestive symptoms occurring in IBS [108].…”

Nanozyme-based medicine for enzymatic therapy: progress and challenges

“…Many diseases related to enzymes can be treated with enzymatic therapy, such like Fabry 's disease (caused by the reduced activity of lysosomal enzyme α-galactosidase A [2]), Pompe disease (caused by the decreased production of acid α-glucosidase enzyme [1]), mucopolysaccharidosis type I (caused by the deficiency of α-L-iduronidase [3]), sphingomyelinase deficiency [4], hypophosphatasia [5], exocrine pancreatic insufficiency (caused by the inadequate production and activity of pancreatic digestive enzymes [1]) etc. Furthermore, enzymatic therapy can also be applied for cancer treatment [6], wound healing [7,8], Alzheimer's disease (AD) [9,10], irritable bowel syndrome and inflammatory bowel disease (IBD) [11,12]. However, enzymatic therapy is limited in practical applications due to the shortcomings of natural enzymes, such as high cost, low stability, low production, hyperimmune response, short half-life [1].…”