CGC Cramer Health Consulting GmbH
Eschborn
Once the diagnosis has been made, the treatment will quickly alleviate the symptoms – this hope is fulfilled in patients with irritable bowel syndrome, who have had diarrhea, flatulence and abdominal pain over the years, to the chagrin of those affected in most cases not. 177 of the 180 irritable bowel patients participating in an online survey (1) conducted jointly by the German Irritable Bowel Self-Help Association, MAGDA (independent information forum for gastrointestinal diseases of the German Society for Neurogastroenterology and Motility) and the information website “Herbal Intestinal Medicine”. despite irritable bowel therapy, still have the intestinal complaints that affect their quality of life. One of the possible reasons could be unrecognized exocrine pancreatic insufficiency (EPI), in which the pancreas produces too few digestive enzymes and food cannot be broken down. The symptoms of EPI and irritable bowel syndrome have many overlaps, which can lead to confusion when making the diagnosis. According to the literature, at least 6% of suspected irritable bowel patients actually suffer from an EPI (2). In the survey, complaints after eating and greasy stools of those affected indicate an enzyme deficiency; however, the determination of pancreatic elastase 1 in the stool to detect the EPI is only carried out in 7% of the examinations ordered. Symptoms caused by an EPI could be effectively reduced by consistently taking medication with digestive enzymes from rice mushrooms (Rizoenzyme) or from the pancreas of pigs with meals.
Irritable bowel or EPI? Fat digestion also makes the difference
In 30.7% of the cases, the therapy-resistant intestinal complaints of the survey participants occur in stressful situations and improve in stress-free times. This is typical of irritable bowel syndrome. However, in 26.2% of cases, the diarrhoea, gas and pain appear about 30 minutes after eating, especially after high-fat meals and large portions (20.7%). These observations, in turn, are more typical of the digestive enzyme deficiency of the pancreas. In addition, 28.3% of the participants stated that they had a light-colored, yellowish, sticky, bulky stool with a lot of air in it, which also smelled bad. This so-called fatty stool is the characteristic symptom of EPI, which occurs in particular in the case of severe disease progression. These survey results could indicate that the number of unreported EPIs among patients with diagnosed irritable bowel syndrome could be significantly higher than the 6% reported in the literature (2). The quality of life of the survey participants is restricted by the recurring intestinal complaints, most of all in social contacts (23.2%) and in coping with everyday life (22.4%). In addition, physical (18.1%) and professional (19.2%) activities are impaired. Appetite and eating habits are also affected (17.1%). In 10.1% of cases, those affected do without visible and in 11.7% hidden dietary fat. In 3.8% of cases only fat-free foods are eaten. These changes in behavior are further indications that the intestinal symptoms could be caused by an EPI, in which the digestion of dietary fats in particular is restricted and therefore triggers symptoms such as fatty stools.
Without a reliable diagnosis, there is no targeted treatment
When diagnosing irritable bowel syndrome, the treating physician should rule out all individually possible causes, including an EPI. Those affected can support their therapists with the diagnosis by providing information on the nature of the stool and the time at which the symptoms appeared. “Unfortunately, EPI is overlooked as a trigger for diarrhea and is more likely to be attributed to people with chronic alcohol consumption or those who have previously had surgery on the pancreas. However, it can also occur independently of these previous illnesses,” says gastroenterologist PD Dr. Miriam Goebel-Stengel, medical director of the Helios Klinik Rottweil and first chairwoman of MAGDA. In the survey, the stool examination to detect the EPI was only carried out in 7% of the cases (see figure). 80.2% of the irritable bowel patients were not even asked about a possible EPI by their therapists. Among the more than 90% of the survey participants who have never been treated for an EPI, there could also be many unrecognized patients with EPI.
EPI-related intestinal problems can be specifically treated. The only and generally recognized treatment for EPI is the ingestion of the digestive enzymes lipase, protease and amylase with all fatty main and snack meals or milk-containing beverages. These enzymes take over the function of the missing endogenous digestive enzymes in breaking down food. The symptoms after eating are significantly alleviated or do not appear at all. Only 16 of the 180 participants in the survey (3.3%) received such a substitution therapy with digestive enzymes from the pancreas of pigs or with vegetarian digestive enzymes isolated from rice mushrooms (Rizoenzyme). “With EPI therapy, for patients who have been plagued by diarrhea for years, with 23.2% of the mentions, the most important criterion is the rapid relief of symptoms,” explains Gerd Müller, 1st Chairman of the German Irritable Bowel Self-Help Association, the results of the Opinion poll. “However, we see from our members that the selection of treatment options and preparations is increasingly determined by criteria such as intolerance, lifestyle, personal preferences, but also by reservations and religious and ideological attitudes of those affected,” Müller continues.
Survey results, literature and illustrations can be requested from [email protected]
Press contact:
CGC – Cramer Health Consulting GmbH
dr Sibylle Bergmann-Matz
T: 06196 / 77 66 – 112
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Andrea Holst
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Original content from: CGC Cramer-Gesundheits-Consulting GmbH, transmitted by news aktuell
