Syndrome of insufficiency of digestion

Syndrome of insufficiency of digestion is a symptom complex associated with a violation of digestion of nutrients due to a deficiency of digestive enzymes (fermentopathy).

The basis for the occurrence of digestive disorders is the genetically determined or acquired inadequate production of digestive enzymes in the small intestine. Moreover, there is either a lack of synthesis of one or several enzymes, or a decrease in their activity, or a change in biochemical reactions that affect enzymatic activity.

Among the congenital fermentopathies, insufficiency of disaccharidases (lactase, saccharase, isomaltase, etc.), peptidase (gluten enteropathy), enterokinase is most often found. Acquired enzymopathies are observed in diseases (chronic enteritis, Crohn's disease, diverticulosis with diverticulitis, etc.) and resection of the small intestine, diseases of other digestive organs (pancreatitis, hepatitis, cirrhosis) and organs of the endocrine system (diabetes, hyperthyroidism) taking some medications (antibiotics, cytostatics, etc.) and irradiation. From the obtained fermentopathies, the most frequent is alimentary enzymopathy, in which the disturbances in the production and activity of enzymes are related to the nature of the food.

Causes of insufficiency of digestion

In the clinical picture of dyspepsia, depending on the prevalence of signs of digestive disorders in various parts of the gastrointestinal tract, gastric, intestinal, and sometimes pancreatogenic forms are distinguished.

The occurrence of gastric dyspepsia is associated with atrophic gastritis, characterized, as is known, by secretory insufficiency, as well as with decompensated stenosis of the pylorus, stomach cancer. The clinical picture of this dyspepsia is characterized by loss of appetite, a feeling of heaviness, bursting and pressure in the epigastric area after eating, belching out air, food with a rotten smell, unpleasant taste in the mouth, nausea, flatulence, diarrhea. In the study of gastric secretion, Achilles or Achlorhydria are identified.

With a coprological examination, the intestinal steatorea is more often detected, when fatty acids, soaps, amylorrhea, creators, an increased content of ammonia, and lowered stercobilin predominate. Excretion of the indicator in the urine is increased, the amount of bilirubin and bile acids in it is increased, and urobilin is reduced. At the X-ray examination of the upper sections of the digestive tract, an accelerated passage of the contrast medium through the small intestine is more often detected.

Symptoms of insufficiency of digestion 

Treatment of dyspepsia primarily involves exposure to the underlying disease. Treatment of nutritional deficiencies in digestion is based on the additional introduction in the diet of the missing substances - proteins, amino acids, vitamins, mineral salts, in order to stimulate the biosynthesis of the protein or prosthetic part of the enzymes.

Treatment of insufficiency of digestion

Insufficiency of parietal digestion is a characteristic sign of chronic diseases of the small intestine, the morphological substrate of which is inflammatory, dystrophic and sclerotic changes in the mucosa, a decrease in the number and damage of the structure of villi and microvilli per unit surface. Occurrence of insufficiency of parietal digestion is promoted by disorders of the enzymatic layer of the intestinal surface and disorders of intestinal peristalsis, in which the transfer of nutrients from the intestinal cavity to the surface of enterocytes is disturbed. Most often this syndrome occurs in chronic enteritis, enteropathy, Whipple's disease, Crohn's disease and other diseases of the small intestine.

The clinical picture is similar to that observed with intestinal dyspepsia and the syndrome of insufficiency of absorption.

To clarify the diagnosis, the activity of enzymes (amylase, lipase) is determined with their subsequent desorption in homogenates of small intestinal mucosa biopsy specimens obtained with aspiration biopsy, which also helps to detect inflammatory and atrophic changes in the mucous membrane. To differentiate the syndrome of insufficiency of parietal and cavitary digestion, in addition to the determination of enzymes, the study of glycemic curves after loads per os by mono-, di- and polysaccharides helps.

In the treatment of significant funds and methods aimed at treating the underlying disease, the elimination of manifestations of the syndrome of insufficiency of absorption. In this regard, it is advisable to appoint a full-fledged, protein-rich diet, eliminating foods and dishes that irritate the intestines (diets № 4, 46, 4c); astringent, carminative, antispasmodic agents, as well as substitution therapy (enzyme and protein preparations, vitamins, anabolic steroids, iron, calcium, etc.).

Insufficient intracellular digestion - primary or secondary enzymopathy, which is based on genetically determined or acquired intolerance of disaccharides. Primary insufficiency of intracellular digestion, as a rule, develops at an early age when food intolerable disaccharide is introduced into food. The acquired insufficiency is more often a consequence of diseases of the small intestine: chronic enteritis, gluten enteropathy, exudative hypoproteinemic enteropathy, ulcerative colitis, involvement in the pathological process of the small intestine in viral hepatitis, etc. In the pathogenesis of the syndrome, the strengthening of fermentation processes as a result of the receipt of uncleared disaccharides in large intestine and activation of microbial flora.

The clinical picture of this form of insufficiency is characterized by persistent diarrhea. Cal is liquid, abundant, foamy.

In the diagnosis helps koprologicheskoy study, which shows a decrease in the pH of faeces, an increase in the content of organic acids. The nature of intestinal disorders can be finally determined by determining the activity of disaccharidases in biopsy specimens of the intestinal mucosa and by studying the glycemic curves after disaccharide loading. When there is a deficiency of the disaccharidase that splits it, the maximum increase in its content from the initial level does not exceed 0.2-0.25 g / l, and the glycemic curve looks flat.

At the basis of treatment of both genetically determined (primary) and secondary disaccharidic insufficiency lies the exclusion from the diet (permanent or temporary) of foods and dishes containing the intolerant disaccharide. With secondary insufficiency, treatment of the underlying disease is necessary, which can lead to restoration of tolerability of the corresponding disaccharide. In some cases it is useful to appoint a phalicor, phenobarbital, nerobol, folic acid, which stimulate the production of intestinal enzymes.

To preventive measures in the case of insufficient digestion of nutritional nature, it is first of all necessary to include balanced rational nutrition, which ensures the physiological needs of the organism in food substances. Essential is the appropriate culinary and technological processing of food products, which allows you to save vitamins and other nutrients, as well as inactivate or destroy harmful natural components (antivitamins, proteinase inhibitors, etc.).

Prevention of dyspepsia of toxic origin is based on the observance of hygienic norms concerning both the composition of food products and the prevention of the entry into them of foreign chemical and biological substances.