Evaluation of the Safety and Efficacy of a Multienzyme Complex in Patients with Functional Dyspepsia: A Randomized, Double-Blind, Placebo-Controlled Study

In vitro simulated study of macronutrient digestion in complex food using digestive enzyme supplement

Digestive enzymes secreted by the body are vital for digestion and nutrient absorption. Enzyme supplements are commonly used to support them in achieving optimal digestion. Herein, the efficacy of digestive enzyme supplement (DigeSEB Super) in digestion of complex food was assessed using INFOGEST simulated static and modified semi-dynamic in vitro digestion models. Digestive enzyme supplement was found to assist the endogenous digestive enzymes to disintegrate the food matrix. Hence, it reduced the viscosity of the gastric digesta by 2.75 fold (p = 0.04) compared to the control digestion (only endogenous digestive enzymes) during the first hour of digestion. Similarly, enzyme supplement showed statistically higher release of reducing sugars in the gastric digestion (p ≤ 0.05) indicating improved digestion of carbohydrates. Further, digestion of proteins and fats was also improved in the presence of enzyme supplement. The kinetic aspects of the semi-dynamic model (transient nature of gastric secretions and gradual acidification) was found to alter the macronutrient digestion compared to the static digestion. Thus, semi-dynamic model should be preferred for the in vitro studies. Overall, current study demonstrated the potential of a digestive enzyme supplement to improve digestion by aiding digestive action of the endogenous enzymes.

Exploring Therapeutic Digestive Enzyme Landscape in India: Current Evidence, Profit Motives, Regulations, and Future Perspectives

This analysis critically examines the profit-driven marketing of digestive enzymes as over-the-counter (OTC) supplements in the context of India, expressing ethical concerns regarding pharmaceutical companies prioritizing financial gain over genuine public health needs within the lucrative OTC supplement market. The review delves into various enzymes, their mechanisms of action, uses, adverse drug reactions, and provides evidence from various studies. The research method involves the exploration of profit-driven strategies employed by pharmaceutical companies, addressing regulatory challenges, investigating the gap between dietary supplements and pharmaceutical drugs, and emphasizing the impact of direct-to-consumer advertising on self-diagnosis and overuse. Additionally, the study reviews various e-pharmacy platforms in India, assessing formulations and pricing. Key findings highlight the diverse formulations on these platforms, exposing insights into cost variations and indicating a regulatory gap that necessitates a comprehensive re-evaluation by Indian and international authorities. The analysis emphasizes the influence of direct-to-consumer advertising on behavior and potential health risks, raising ethical concerns about oversimplified health claims that overlook the necessity for individualized treatment plans. In conclusion, the study underscores the ethical complexity of prioritizing profit over public health and advocates for regulatory re-evaluation, exploring broader implications such as cultural influences and alternative therapies. The evolving landscape, featuring plant-based and microbe-derived alternatives, is presented as transformative, particularly in conditions like celiac disease.

Efficacy of digestive enzyme supplementation in functional dyspepsia: A monocentric, randomized, double-blind, placebo-controlled, clinical trial

Functional dyspepsia is a form of dyspepsia lacking in clear causes following clinical assessment. Dyspepsia is characterized by episodic or persistent abdominal pain or discomfort of the upper gastrointestinal (GI) tract. Its onset has been linked with a deficiency or dysfunction of digestive enzymes. Thus, consumption of digestive multi-enzymatic preparations may be effectively used for the reduction of symptoms. The aim of this study is to assess the effectiveness and tolerability of the supplementation of a normal diet with a multi-enzyme blend obtained from fungal fermentation, in a randomized, placebo-controlled, double-blind, clinical trial. Enrolled subjects (n = 120, male: 63, female: 57), aged 18-59 years, were randomized (allocation ratio 1:1) to receive either 2 capsules per day of the food supplement (containing 200 mg of the multi-enzyme blend/capsule) or placebo, for 2 months. The primary outcome of the study (i.e., improvements in quality of life) was evaluated by the Nepean Dyspepsia Index-SF (NDI-SF) questionnaire, while the secondary outcomes (i.e., severity of pain and the quality of sleep) were assessed through the Visual Analogue Scale (VAS) and Pittsburgh Sleep Quality Index (PSQI) questionnaire. The results showed an improvement in NDI-SF1, NDI-SF2-5, VAS, and PSQI scores in subjects treated with the multi-enzyme blend, indicating an improvement in quality of life and of sleep, and a decreased severity of pain, following the supplementation with digestive enzymes, without side effects. In conclusion, treatment with digestive enzymes was found to be effective in the reduction of functional dyspepsia symptoms and in the improvement of sleep quality, and is well-tolerated.

Fungal digestive enzymes promote macronutrient hydrolysis in the INFOGEST static in vitro simulation of digestion

The objective of this study was to test the hydrolytic efficacy of 6 fungal enzymes in the INFOGEST static in vitro simulation of gastrointestinal (GI) digestion. First, the INFOGEST protocol was adapted for testing of exogenous enzymes. Second, a dose-response study of 3 individual fungal proteases, a lipase, and an amylase with glucoamylase demonstrated improved dietary protein, lipid, and carbohydrate hydrolysis, respectively, from an oral nutritional supplement (ONS) under simulated gastric or GI conditions, compared to pepsin and pancreatin-based control conditions. Third, a combination of the 6 enzymes (BC-006) improved macronutrient digestion, including enhanced release of individual amino acids from ONS and mixed meal substrates. Finally, we validated digestive models of aging and proton pump inhibitor (PPI) use, and showed that BC-006 improved gastric digestion under these compromised digestive conditions. The INFOGEST static simulation is a feasible tool to rapidly screen and profile exogenous enzymes for digestive efficacy in vitro.

Complementary and Alternative Medicine for Functional Gastrointestinal Disorders

The relevance of functional gastrointestinal (GI) disorders and their impact on quality of life for many patients has become an increasingly important topic in gastroenterology. A gastroenterologist can expect to see 40% of patients for motility and functional GI disorders, thus highlighting the necessity for physicians to have a strong foundation of knowledge in treatment strategies for these patients with complex disorders. A significant number of patients who suffer with functional GI disorders turn to complementary and alternative therapies to maintain control over their symptoms and often are happy with therapeutic results. This narrative presents information and treatment algorithms for the gastroenterologist to better understand and use some of the most common complementary and alternative therapies for patients with functional dyspepsia, nausea and vomiting, and irritable bowel syndrome.

An orally administered magnoloside A ameliorates functional dyspepsia by modulating brain-gut peptides and gut microbiota

AIMS

Functional dyspepsia (FD) is very common worldwide with a high prevalence of 10%-30%, and it becomes a heavy burden to patients because of its hard to be cured. In our previous study, phenylethanoid glycosides were found to exist in Houpo, a traditional Chinese medicine commonly used for the treatment of abdominal distention, pain and dyspepsia. In the present study, the effect of magnoloside A (MA), a main phenylethanoid glycoside in Houpo, on FD was firstly evaluated and its potential mechanism was concluded.

MATERIALS AND METHODS

MA was orally administered consequently for 3 weeks, and its effect on a FD rat model established through transient neonatal gastric irritation and mature alternate-day fasting was tested. Levels of brain-gut peptides and inflammatory factors in blood or tissues were determined by ELISA methods. Meanwhile, the gut microbiota was analyzed by 16S rRNA gene sequencing and short chain fat acids were determined by GC/MS.

KEY FINDINGS

MA exhibited anti-FD activities by fastening the delayed gut emptying rate of FD rat and increasing the levels of gastrin, motilin, and calcitonin gene related protein; and decreasing the levels of 5-hydroxytryptamine, nitric oxide synthase, and vasoactive intestinal peptide. On the other hand, MA can modulate the composition of gut microbiota, resulting in the variation of the short chain fat acids.

SIGNIFICANCE

MA ameliorated FD rats by modulating of the secretion of related brain-gut peptides and altering the composition of intestinal microbiota.