Dyspepsia, also known to many as indigestion or difficult digestion, refers to a group of troublesome abdominal symptoms such as pain, discomfort in the stomach or chest, bloating, flatulence, belching and abdominal fullness which is affecting most populations around the globe.
These disturbing symptoms, which are often experienced during or after eating, may vary in intensity and frequency. Symptoms of indigestion are often triggered by consuming certain foods such as fatty or spicy foods, beverages like caffeine, alcohol, soft-drinks and carbonated beverages, overeating, smoking, anxiety, as well as intake of certain medications such as antibiotics, anti- inflammatory drugs and iron supplements.
75% of Cases of Dyspepsia are Considered Functional Dyspepsia
For 25% of cases of dyspepsia, the symptoms could be due to an underlying peptic ulcer, reflux, infections, hepatitis, gallstone, pancreatitis, intestinal obstruction, or stomach cancer and would require appropriate and urgent medical care.
On the other hand, majority of cases of dyspepsia have no clear identifiable cause and would be classified as functional dyspepsia. Functional dyspepsia encompasses a group of symptoms of persistent or recurrent upper abdominal pain, discomfort, bloating, and belching in the absence of organic or structural disease that can likely explain the symptoms.
In an international survey published in the prestigious medical journal Lancet in 2018, approximately 10% of the adult population fulfils symptom-based criteria for functional dyspepsia.
One mechanism offered to explain the occurrence of functional dyspepsia is the deficiency of digestive enzymes. This is supported in a study done by a group of researchers from the Osaka City University Graduate School of Medicine in 2017 which found that approximately 70% of patients with treatment resistant functional dyspepsia had deficiencies in digestive enzymes.
Onkar Swami and Neel Shah authored a review on functional dyspepsia and the role of digestive enzymes published in the International Journal of Basic & Clinical Pharmacology. They found that digestive enzyme deficiency could either be an actual deficiency from organic causes such as abdominal diseases, gastrointestinal su rgery, and nutritional deficiency, or a relative deficiency from poor eating habits such as “eating on the run” or eating late in the day and inadequate chewing of food. Secretion of the digestive enzyme may also be altered among aging individuals with linear decreasing trend reported after the fourth decade of life. Excessive consumption of fat and alcohol and high meat intake may also result in enzyme deficiency.
Dealing with Dyspepsia
Dealing with dyspepsia involves treatment of the underlying cause. Management of symptoms through medications such as antacids, prokinetics, acid suppressants, antibiotics for infection, and antidepressants to ease discomfort and pain could become a tricky exercise as the symptoms tend to recur and intake of some drugs brings unpleasant side effects.
To ease dyspepsia, patients are often advised to practice lifestyle modification that includes elimination of stress and adequate sleep. Avoiding smoking and regular exercise are part of lifestyle changes.
Eating the right food the right way is also central in the control of dyspepsia. Patients must remember to eat less fatty and spicy food, avoid alcohol, soft-drinks and coffee. Chewing the food gradually or slowly helps to avoid gas to enter the stomach.
Supplementation with oral enzymes is a commonly employed management approach for functional dyspepsia. Oral preparations of enzyme supplements deliver digestive actions generated by multiple enzymes which are naturally produced by the pancreas. The various digestive enzymes break down or digest the food nutrients, carbohydrates, fats and proteins to smaller units which are then assimilated by the body. Symptoms of dyspepsia are ameliorated by oral enzyme supplementation through their action of aiding the digestive process. Supplementation of digestive enzymes in functional dyspepsia are reported to significantly reduce the symptoms of flatulence, bloating, belching, fullness and distress after meals.
Digestive enzyme preparations, according to Swami and Shah enhance digestive power, help in the complete absorption of nutrients, and match the body’s natural metabolism. Preparations of digestive enzymes do not interfere with internal metabolism and are well tolerated with minimum side effects.
In a controlled trial published just this February 2020, Dr. G.S. Wang and a team of gastroenterologists and gerontologists examined how a blend of digestive enzymes compared with the administration of Mosapride, a drug that promotes gastric motility, in the treatment of symptoms of dyspepsia in the elderly, particularly the type most felt after eating, also known as post-prandial discomfort syndrome. 323 patients were either treated with digestive enzymes, Mosapride, or a combination of the two and it was found that the combination treatment as well as administering digestive enzymes alone had significantly better outcomes than when Mosapride was given alone.
In cases where patients are bothered by nagging or recurring symptoms of dyspepsia, they should consult their doctors for appropriate medical evaluation and management.
Bytzer P, Talley NJ. Dyspepsia. Ann Intern Med.
Aziz I, Palsson OS, Törnblom H, Sperber AD, Whitehead WE, Simrén M. Epidemiology, clinical characteristics, and associations for symptom-based Rome IV functional dyspepsia in adults in the USA, Canada, and the UK: a cross-sectional population-based study. Lancet Gastroenterol Hepatol.
Fujikawa Y, Tominaga K, Tanaka F, et al. Postprandial Symptoms Felt at the Lower Part of the Epigastrium and a Possible Association of Pancreatic Exocrine Dysfunction with the Pathogenesis of Functional Dyspepsia. Intern Med.