Enzyme preparations. All About Enzymes

Preparations containing pancreatic enzymes have been produced for over a hundred years. Their main constituents, as a rule, are amylase, protease and lipase contained in pancreatin, a powder obtained from pork pancreas. Assessment of enzyme activity is carried out taking into account units of the European Pharmacopoeia or International Units (they are identical). The lipase activity of one mg of dry pancreatin varies from 15 to 45 units. Protease, amylase and lipase are contained in the composition in optimal proportions (the drug should not contain many proteases, since they reduce the activity of lipase).

Preparations containing enzymes are prescribed in a variety of cases of digestive disorders. As a rule, they help to eliminate the maldigestion syndrome (feeling of heaviness and discomfort and pain in the epigastric region, diarrhea, flatulence, polycalculia, belching, nausea, etc.), pain. In addition, they are well tolerated and have virtually no side effects and contraindications.

Enzyme preparations are indicated for use in many cases. Their use is possible in case of gastric diseases (chronic gastritis, characterized by decreased secretory function, a condition after resection of the stomach, etc.), diseases of the gallbladder, liver (condition after cholecystectomy, chronic cholecystitis, chronic hepatitis), diseases of the pancreas (cystic fibrosis, chronic pancreatitis, etc.), intestinal diseases (chronic enterocolitis and enteritis), functional dyspepsia, impaired parietal digestion (Crohn's disease, disaccharidase deficiency, gluten enter patii), etc.

Enzyme preparations are indicated for use mainly by people suffering from chronic pancreatitis, characterized by impaired exocrine function, as well as by patients who underwent pancreatic resection. Ensuring normal digestion is possible when the body receives a sufficient amount of lipase (at least 400 thousand IU daily). When choosing a medicine, you should first of all pay attention to the activity of lipase, since the secretion and production of lipase is violated most of all. It is vital for a patient who has completely removed the pancreas to take medications containing a large number of enzymes every day.

In an acidic environment, the activity of pancreatic enzymes decreases, therefore, such drugs are available in shells resistant to an acidic environment. In recent years, drugs with microspheres in the form of capsules with two acid-resistant shells (Pantsitrat, Likreaz, Creon) have appeared on the shelves of pharmacies. The acidic environment instantly destroys the outer capsule shell, and the small granules that make up the basis of the drug are mixed with the chyme of the stomach. The shells of granules resistant to acidic environment disintegrate in the duodenum by increasing the pH.

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Some nutritionists today offer a special “shock” diet plan for those who have difficulty building mass. Its essence is to get exactly 2000 kilocalories per day in excess of the norm and “help” yourself with digestive enzymes. Theoretically, the more you eat, the more nutrients your body absorbs. And the more he assimilates, the more effective is the mass gain. Moreover, a 2009 Buford TW study found that digestive enzymes can accelerate muscle recovery and growth.

But is it always reasonable? Excess calories are always a risk of body fat. And digestive enzymes will not help here: they do not affect how calories are distributed in the body. Getting extra calories, even if accompanied by enzymes, you will gain not only muscle mass, but also fat.

The use of enzymes in bodybuilding will be reasonable in two cases: 1) in case of digestive disturbance arising from overloading the gastrointestinal tract with food; 2) for ectomorphs, who gain mass with great difficulty.

Digestion basics

Before deciding on the intake of enzymes, you need to get an elementary idea of ​​what, in fact, digestion. Digestion is a process aimed at breaking down the food that enters the body into chemical constituents. This allows nutrients to be absorbed into the blood, i.e. assimilated and used for its intended purpose. Cleavage and absorption are two components that are necessary for the essential nutrients (proteins, carbohydrates and fats), vitamins and minerals to penetrate from the intestines into the blood.

Having absorbed these substances, the body directs them to various tissues to ensure growth, recovery, energy production, or simply for deposition.

Digestive enzymes are involved in almost every chemical reaction that occurs in the body, and act as catalysts for these reactions in all of our life support systems. During digestion, enzymes are responsible for reactions that break down long chains of food molecules into simpler components. And these components then penetrate the blood through the walls of the intestine.

Do you need extra enzymes?

If you train and recover adequately, but there is no progress, then obviously the problem lies in the insufficient intake of calories. It is necessary to gradually increase the calorie content of the diet. But only due to quality products, observing the rules of nutrition. Continue to build calories for at least 2 weeks, and then start making conclusions. If strength and mass growth still does not occur, check if you have symptoms of a lack of digestive enzymes in your stomach:

  • Unpleasant sensations in the stomach immediately after eating.
  • Strong belching after eating.
  • The feeling of "fullness" in the stomach, which lasts long enough.
  • Indigestion after a hearty meal.
  • An upset stomach after several small meals.

Another common type of digestive disorder is a lack of enzymes in the small intestine. Other symptoms are characteristic of it:

  • "Seething" and bloating.
  • Discomfort in the abdomen.
  • Flatulence
  • Frequent diarrhea.
  • Brightly colored, unformed or pungent stools.
  • Mucus in the stool.

If, when switching to a diet with a high calorie content, you notice the appearance of these symptoms, it is likely that you need to take digestive enzymes. To find out for sure, lower your calories to your usual level and see what happens to your symptoms. If they disappeared, then you really need enzymes.

Please note that some of these symptoms can be caused not only by a lack of enzymes, but also by some diseases, food allergies, neuroses, and hypersensitivity. If you are not sure of the reason, consult your doctor.

The composition of enzyme preparations

In case of digestive disorders, various drugs containing enzymes are used. Depending on the composition, enzyme preparations can be divided into several groups:

  1. Extracts of the gastric mucosa, the main active ingredient of which is pepsin (abomin, acidinpepsin).
  2. Pancreatic enzymes represented by amylase, lipase and trypsin (panzinorm forte-N, pancreatin, pancytrate, mesim forte, creon).
  3. Combined enzymes containing pancreatin in combination with bile components, hemicellulose and other additional components (panzinorm forte, digestal, festal, enzistal).
  4. Plant enzymes represented by papain, fungal amylase, protease, lipase and other enzymes (pepphys, oraza).
  5. Combined enzymes containing pancreatin in combination with plant enzymes, vitamins (wobenzym).
  6. Disaccharidases (tilactase).

First group enzymes are mainly aimed at correcting the secretory dysfunction of the stomach. The pepsin, cathepsin, and peptidases contained in their composition break down almost all natural proteins. These drugs are used mainly for atrophic gastritis, they should not be prescribed for diseases that occur against a background of normal or increased acid formation.

Drugs Including pancreatic enzymesare used to correct digestive disorders, as well as to regulate the functions of the pancreas. Traditionally, complex preparations containing the main enzymes of the pancreas of domestic animals (primarily lipase, trypsin, chymotrypsin and a-amylase) are used for this. These enzymes provide a sufficient spectrum of digestive activity and contribute to stopping the clinical signs of exocrine pancreatic insufficiency, which include a decrease in appetite, nausea, rumbling in the abdomen, flatulence, steato-, creato- and amylorrhea.

Preparations differ in the activity of the components, which should be considered when choosing them.

Included in the complex amylase decomposes starch and pectins to simple sugars - sucrose and maltose. Amylase breaks down mainly extracellular polysaccharides (starch, glycogen) and practically does not participate in the hydrolysis of plant fiber.

Proteases in enzyme preparations, they are mainly represented by chymotrypsin and trypsin. The latter, along with proteolytic activity, is able to inactivate cholecystokinin-releasing factor, resulting in a decrease in blood cholecystokinin and pancreatic secretion by the feedback principle.

In addition, trypsin is an important factor in regulating bowel motility. This is a result of interaction with the RAP-2 receptor enterocytes.

Lipase participates in the hydrolysis of neutral fat in the small intestine.

Combination drugs along with pancreatin, they contain bile acids, hemicellulase, simethicone, plant choleretic (turmeric), etc.

Introduction to the drug bile acids significantly changes its effect on the function of the digestive glands and motility of the gastrointestinal tract. Preparations containing bile acids increase pancreatic secretion and choleresis, stimulate intestinal and gall bladder motility. Bile acids increase the osmotic pressure of intestinal contents. Under conditions of microbial contamination of the intestine, their deconjugation occurs, which in some cases promotes the activation of cAMP enterocytes with the subsequent development of osmotic and secretory diarrhea.

Combined preparations containing components of bile and hemicellulase create optimal conditions for the rapid and complete breakdown of proteins, fats and carbohydrates in the duodenum and jejunum. Drugs are prescribed for inadequate exocrine pancreatic function in combination with pathology of the liver, biliary system, with violation of chewing function, sedentary lifestyle, short-term errors in food.

The presence of bile, pepsin and amino acid hydrochlorides (panzinorm forte) components in combined preparations along with pancreatic enzymes ensures normalization of digestion in patients with hypoacid or anacid gastritis. In these patients, as a rule, the functions of the pancreas, bile formation and bile secretion suffer.

Hemicellulase, which is part of some drugs (festal), promotes the breakdown of plant fiber in the lumen of the small intestine, normalization of intestinal microflora.

Many enzyme preparations contain simethicone or dimethicone, which reduce the surface tension of gas bubbles, as a result of which they disintegrate and are absorbed by the walls of the stomach or intestines.

Herbal enzyme preparations contain papain or fungal amylase, protease, lipase (pepfiz, oraza). Papain and proteases hydrolyze proteins, fungal amylase - carbohydrates, lipase, respectively - fats.

In addition to the three above groups, there are small groups of combined enzyme preparations of plant origin in combination with pancreatin, vitamins (wobenzym) and disaccharidases (tilactase).

Product release form is an important factor in determining the effectiveness of treatment. Most enzyme preparations are available in the form of dragees or tablets in enteric coatings, which protects the enzymes from being released in the stomach and destroyed by hydrochloric acid of gastric juice. The size of most tablets or dragees is 5 mm or more. Nevertheless, it is known that solid particles with a diameter of not more than 2 mm can be evacuated from the stomach at the same time as food. Larger particles, in particular enzyme preparations in tablets or dragees, are evacuated during the inter-digestive period when the food chyme is absent in the duodenum. As a result, drugs do not mix with food and are not actively involved in digestion.

To ensure fast and homogeneous mixing of enzymes with food chyme, new generation enzyme preparations were created in the form of microtablets (pancytrate) and microspheres (creon, lycrease), the diameter of which does not exceed 2 mm. The preparations are coated with enteric (enteric) membranes and are enclosed in gelatin capsules. When ingested, gelatin capsules dissolve quickly, microtablets mix with food and gradually enter the duodenum. At pHs of the duodenal contents above 5.5, the membranes dissolve and the enzymes begin to act on a large surface. In this case, the physiological processes of digestion are practically reproduced, when pancreatic juice is excreted in portions in response to the periodic intake of food from the stomach.

Brief pharmacological characteristics

Acidin-Pepsin - a preparation containing a proteolytic enzyme. Obtained from the mucous membrane of the stomach of pigs. Tablets of 0.5 and 0.25 g contain 1 part pepsin, 4 parts acidin (betaine hydrochloride). They are prescribed for hypo- and anacid gastritis, 0.5 g 3-4 times a day with meals. The tablets are pre-dissolved in 1/2 cup of water.

Wobenzym - a combined preparation containing highly active enzymes of plant and animal origin. In addition to pancreatin, it contains papain (from the plant Carica Papaya), bromelain (from ordinary pineapple) and rutoside (vitamin P group). It occupies a special place in the series of enzyme preparations, since, along with pronounced enzymatic properties, it has anti-inflammatory, decongestant, fibrinolytic and secondary analgesic effects. The range of applications is very wide. The dose is set individually - from 5 to 10 tablets 3 times a day. The U.S. Food and Drug Administration has banned the distributor of the drug from declaring its effectiveness in any disease, since there is no scientific evidence of its safety and effectiveness. 1

Digestal - contains pancreatin, cattle bile extract and hemicellulase. The drug is prescribed for 1-2 tablets 3 times a day during or after meals.

Creon - a preparation in the gelatin capsule of which contains a large amount of pancreatin in granules resistant to hydrochloric acid.The drug is characterized by rapid (within 4–5 min) dissolution of gelatin capsules in the stomach, release and even distribution of granules resistant to gastric juice throughout the chyme. Granules freely pass through the pyloric sphincter simultaneously with the chyme into the duodenum, completely protect pancreatin enzymes during passage through the acidic environment of the stomach, and are characterized by the rapid release of enzymes when the drug enters the duodenum.

Lycrease - an enzyme preparation based on an extract obtained by grinding, degreasing and drying a fresh or frozen pig pancreas. Capsules contain microspheres with a diameter of 1-1.2 mm, containing pancreatin, are stable and do not collapse in the stomach with a pH below 5.5. With dyspeptic disorders, 1-3 capsules per day are prescribed, the dosage can be increased to 6 capsules per day.

Mezim Forte - more often prescribed for the correction of short-term and minor pancreatic dysfunctions. Mezim-forte tablets are coated with a special glaze coating that protects the components of the drug from the aggressive effects of the acidic environment of the stomach. Apply 1-3 tablets 3 times a day before meals.

Mercenzyme - a combined preparation that contains 400 mg of pancreatin, 75 units of bromelain and 30 mg of bovine bile. Bromelaines are a concentrated mixture of proteolytic enzymes extracted from fresh fruits of pineapple and its branches. The drug is two-layer. The outer layer is bromelain, which is released in the stomach and exhibits a proteolytic effect. The inner layer is resistant to hydrochloric acid of the stomach, enters the small intestine, where pancreatin and bile are released. Bromelaines remain effective over a wide pH range (3.0–8.0), so the drug can be prescribed regardless of the amount of hydrochloric acid in the stomach. Merkenzyme is prescribed 1-2 tablets 3 times a day after meals.

Panzinorm forte - the drug consists of an extract of the gastric mucosa, an extract of bile, pancreatin, amino acids. The gastric mucosa extract contains pepsin and cathepsin with high proteolytic activity, as well as peptides that promote the release of gastrin, subsequent stimulation of the gastric glands and the release of hydrochloric acid. Panzinorm is a two-layer drug. The outer layer contains pepsin, cathepsin, amino acids. This layer dissolves in the stomach. The inner layer is acid resistant, soluble in the intestines, contains pancreatin and bile extract. Panzinorm is one of the few drugs that, along with substitution, has a stimulating effect on digestion, which makes it the preferred drug in bodybuilding. The drug is taken 1-2 tablets with meals 3-4 times a day.

Pancreatin - a preparation of the pancreas of cattle containing enzymes. The daily dose of pancreatin is 5-10 g. Pancreatin is taken 1 g 3-6 times a day before meals.

Pancytrate - a new generation drug with a high content of pancreatin. Has pharmacodynamics similar to creon. Gelatin capsules contain microtablets in a special enteric coating resistant to gastric juice, which guarantees the release of all enzymes in the intestine. Assign 1 capsule 3 times a day.

Tilactase - a digestive enzyme representing lactase, which is located in the brush border of the mucous membrane of the jejunum and the proximal ileum. Breaks down lactose into simple sugars. Assign inside of 250-500 mg before consuming milk or dairy products. The drug can be added to foods containing lactose.

Festal, enzistal, panzistal - combined enzyme preparations containing the main components of the pancreas, bile and hemicellulase. Apply 1-3 dragees with meals 3 times a day.

Digestive Enzymes in Supplements (as a rule, the dosage is extremely underestimated)

Indications for use

Enzymes are secreted by endocrine glands. Enzymes are involved in each of the stages of digestion, which begins already in the oral cavity. The main indication for the appointment of these drugs is enzyme deficiency. This happens with the following diseases:

  • Inflammatory pathologies of the digestive tract: gastritis, pancreatitis, cholecystitis, hepatitis, cholangitis, colitis.
  • Autoimmune bowel disease: Crohn's disease, ulcerative colitis.
  • Irritable bowel syndrome, functional dyspepsia.
  • Congenital fermentopathy: lactase deficiency, cystic fibrosis, celiac disease.
  • Diseases of the teeth leading to poor chewing of food.
  • After surgical interventions with general anesthesia, enzymes can be prescribed to patients for the period of restoration of bowel function.
  • Enzymes are necessary as replacement therapy for individuals after resection of the stomach, pancreas, removal of the gallbladder.

Also, medications may be needed for people taking long-term anti-inflammatory and antibacterial drugs, as well as hormones and cytostatics.

Recommended: To avoid the development of enzyme deficiency, use only well-prepared foods, eat often in small portions, diversify your diet with dairy products, fruits, vegetables, cereals.

How is enzyme deficiency manifested?

The lack of enzymes begins to manifest itself as symptoms of digestive disorders: heartburn, heaviness in the stomach, belching, increased gas formation. Due to impaired absorption and assimilation of beneficial substances, problems with skin, nails and hair appear, and the general condition is disturbed. A person lacks vitamins and minerals, fatigue, drowsiness appears, and working capacity decreases.

Interesting: Enzyme preparations can be prescribed as a component of complex therapy in dermatology, gastroenterology, allergology and other areas of medicine.

Some patients, aware of digestive problems, use these drugs periodically, before a feast. This is not correct, since overeating in conjunction with the uncontrolled use of enzymes disrupts the function of the digestive tract and leads to its consequences. Therefore, enzyme preparations should be prescribed by a specialist and taken reasonably, and not in cases where a person can not control his appetite.

Classification of enzyme preparations

  1. extracts of the gastric mucosa containing pepsin (abomin, acidinpepsin, pepsin, acidin). They are used for atrophic gastritis with reduced acidity, and are contraindicated in case of exocrine pancreatic insufficiency.
  2. pancreatic enzymes containing amylase, lipase, and trypsin (pancreatin, pancytrate, mesim forte, creon)
  3. pancreatic enzymes with the addition of bile (digestal, festal), cellulose and other components (panzinorm-forte, enzistal). Hemicellulose in the festival contributes to the normalization of stool and microflora, bile stimulates bile secretion, motility and secretion, and fights constipation. This group of drugs is used for the combined pathology of the liver and pancreas, constipation, physical inactivity, short-term errors in the diet. They can not be used for a long time and with a spastic type of biliary dyskinesia and IBS.

Preparations containing bile cannot be used for:

  • pancreatitis
  • hepatitis
  • ulcers of any localization
  • gastrointestinal inflammation
  • diarrhea

4. plant enzymes - papain, etc. (pephyphus, oraza)

The group of plant enzymes includes:

  • nygedase - contains only plant lipase, is used together with pancreatin,
  • oraza - a complex of enzymes of fungal origin (lipase, amylase, maltase, protease from aspergillus fungus),
  • pepphyse - fungal diastase (amylase), papain and simethicone,
  • solisim - penicillin fungus lipase,
  • Somilase - solisim and fungal amylase,
  • unienzyme - fungal amylase, papain, simethicone, activated carbon, nicotinamide,
  • Wobenzym - pancreatin, papain, bromelain, trypsin, chymotrypsin, rutoside,
  • merkensim - pancreatin, bromelin, bile,
  • phloenzyme - bromelain, trypsin, rutoside.

They are prescribed for allergies to animal proteins. However, plant enzymes cannot be used for bronchial asthma and allergies to fungi and antibiotics of the penicillin series. Plant enzymes are not widely used because 75 times less effective than animals.

5. pancreatic and plant enzymes (wobenzym, phloenzyme)

Separately, there is a combined preparation Panzinorm. It contains pancreatic enzymes, pepsin and amino acids and can be used in patients with low acidity, impaired pancreatic function and bile secretion.

Types of medicines with enzymes

Enzyme preparations are obtained from the pancreas of pigs, the pancreas of cattle and plants. Preparations can be either purely animal or plant origin, or combined. When prescribing this or that remedy, the doctor is guided by its main enzyme components:

  • Pepsin - an enzyme of the gastric mucosa,
  • Pancreatic enzymes - lipase, amylase and trypsin - obtained from the pancreas of pigs or cattle,
  • Bile Acids
  • Enzymes of plant origin,
  • Enzyme preparations that break down lactose (used for lactase deficiency),
  • Combined drugs.

Important: All enzyme preparations begin to act no earlier than 20 minutes after administration, therefore it is recommended to use them immediately before meals.

Pepsin Medications

Pepsin is an enzyme secreted by the gastric mucosa. It is necessary for the breakdown of proteins. Pepsin drugs, namely Pepsin, Abomin, and Pepsidal, are used in people with stomach diseases, most often with atrophic gastritis.

Proteins are important components of energy metabolism, and with insufficient production of pepsin weakness and anemia develop. In addition, food from the stomach enters the intestine insufficiently processed, which requires intensive work from the digestive tract and can cause intestinal dysfunction. Enzyme preparations containing pepsin are prescribed to patients as lifelong replacement therapy after gastrectomy.

Pancreatic enzymes

Creon, Mezim-forte, Pancreatin - all these are tablets for digestion with the same active substance - pancreatin. The active component of the drug is enclosed in granules that are coated with a protective shell. Pancreatin is an enzyme of the pancreas that acts in the small intestine, so the protective shell allows you to deliver the active substance exactly to the target.

There are many indications for the use of the drug, but since pancreatin replaces the natural pancreatic enzymes, the medicine is prescribed mainly for pathologies of this organ. Pancreatic enzymes are safe and can be used for a long time, if necessary. For example, in case of chronic pancreatitis and after resection (removal of a part) of the pancreas, Creon, Pancreatin or Mezim-forte may be recommended before each meal as a replacement therapy.

Important: If the doctor recommended drinking enzymes all the time, then you should listen to it so as not to disturb the pancreas function even more. And an alternative to this can be a strict diet for an indefinite period.

Bile Acids

In addition to bile acids, these drugs also contain the pancreatic enzyme - pancreatin. Therefore, you can take them with pathologies of the pancreas. However, agents with bile acids are not always interchangeable with pancreatin (Mezim), because often patients are allergic to bile components. Therefore, these drugs are used only in people with impaired liver function.

Plant Enzymes

Enzymes to improve digestion of plant origin have a complex effect on the gastrointestinal tract. They improve the motility of the stomach and intestines, reduce gas formation, improve the absorption of beneficial elements, stimulate metabolism and normalize the breakdown of fats, proteins and carbohydrates.

Medications can be used for diseases of the liver, pancreas, small and large intestines, as well as for the normalization of digestion in the postoperative period.

Despite the diverse effects, these drugs are rarely prescribed, since there are more effective enzyme preparations of plant origin. Most often, enzymatic preparations of plant origin are prescribed before preparing for the study of the digestive tract.

Such funds include Pepfiz, Unienzyme, Solizim, Oraza, Sestal. Many enzyme preparations of plant origin, in particular, Pepfiz, are contraindicated in children and pregnant women.

Combination drugs

Wobenzym is the main representative. Contains plant and animal enzymes. The drug not only replaces enzyme deficiency, but also has anti-inflammatory, decongestant, fibrinolytic and analgesic effects. Due to this, Wobenzym is an excellent tool in the treatment of autoimmune bowel diseases (Crohn's disease and ulcerative colitis).

The tool is actively used in rheumatology, traumatology, endocrinology, dermatology and other areas of medicine. Despite the absence of a specific action, the drug has excellent results, practically has no side effects and can be used for a long time, for 1 month or more.

Medicines for children and pregnant women

Enzyme preparations for improving digestion have practically no contraindications, except for hypersensitivity to the components of the drug, so many of them are allowed for use by children. However, it is impossible to give a medicine to a child alone, since the dose and course of taking the drug varies depending on age and body weight. Particularly cautious drugs are prescribed for children under 3 years old.

Children are most often prescribed Abomin, Mezim-forte, Pancreatin and Creon preparations, selected depending on the condition.

Important: Pancreatic preparations (containing pancreatin) cannot be used for acute pancreatitis and exacerbation of chronic inflammation.

In pregnant women, due to physiological changes in the body, signs of digestive disorders can be observed. Heartburn, flatulence, abdominal pain, constipation and diarrhea - all these manifestations are symptoms of enzyme deficiency. A special diet will help them best, but sometimes a gynecologist can prescribe enzymes.

Also, funds for improving digestion during pregnancy may be needed by women with chronic pancreatitis. The variant of the medicine and its dose are selected by the gynecologist together with the therapist or surgeon who leads the patient.

Recommended: In the first trimester, the most important organs of the baby are laid, so the amount of medication consumed by a woman should be minimized. Taking any drug without consulting a gynecologist is prohibited. How then to improve digestion? Follow a diet and eat often in small portions.

Looking at the variety of enzyme preparations, patients should understand that one remedy is not always an analogue of another and not every medicine works effectively for various diseases. Therefore, only a reasonable prescription of the medicine by the attending physician will help to cope with enzyme deficiency.

How to choose an enzyme preparation

  • depending on the acidity of the gastric juice: with a reduced acidity showing panzinorm forte, in other cases, other drugs can be used,
  • with insufficient bile secretion, enzyme and bile complexes are used,
  • preparations containing simethicone or dimethicone are well suited for patients with flatulence and IBS (pephysus, unienzyme),
  • in children, with mild pancreatitis, episodic overeating, chronic gastritis and enterocolitis, functional dyspepsia, gall bladder dysfunction, plant enzymes can be used.

It must be remembered that in the first 7-10 days of acute pancreatitis (and 3-5 days of exacerbation of chronic), as well as allergies to animal protein, you need to ABSTAIN from the appointment and administration of enzymes!

If enzymes are effective ...

... stool is normalized, fats, starch and undigested muscle fibers (creatorrhea) disappear from it, body weight is normalized.

The dose is selected individually for a week, you can start with 1000 PIECES of lipase per 1 kg of body weight per day, that is, 60,000-70000 PIECES, divided into 3-4 meals. In case of severe violations, the dose increases to 4000-5000 units, the drug is discontinued after the disappearance of symptoms and disorders in the coprogram.

If enzymes are ineffective ...

... then there are several reasons for this:

  • insufficient dosage, improper storage with loss of enzyme activity, improper administration,
  • inactivation of enzymes in the acidic contents of the stomach go duodenal ulcer,
  • dysbiosis.

When diarrhea and steatorrhea in no hurry to disappear?

With IBS and organic intestinal pathology, the absorption of fats during normal digestion may be impaired, while the fat in the stool remains. In this case, it is necessary to increase the dose of the drug.

With high acidity of the gastric and intestinal contents, bile does not emulsify fats well, and enzymes are inactive, which also causes steatorrhea. Antacids and proton pump inhibitors help here.

And finally, if the enzyme leaves the stomach at the same time as food, it can also cause problems that can be solved by proper administration (on an empty stomach or with food, never after, because it reduces their effect to nothing) and the use of microencapsulated forms. Creon and similar preparations contain particles less than 2 mm in diameter, which allows parietal digestion and the simultaneous release of the enzyme from the stomach - together with portions of food).

Watch the video: The mechanism of action of the enzyme preparation Wobenzym (December 2019).