Digestive Enzyme

Disorder
Ahmad Fariz Malvi Zamzam Zein, dr., Sp.PD
SMF ILMU PENYAKIT DALAM
RSUD WALED – FK UNSWAGATI
  Major physiological processes of GI tract: digestion,
secretion, motility & absroption,.
 Digestion: nutrients in food  absorbable:
iNTRODUCTION  Physical process (chewing, peristalsis)
 Chemical process (digestive enzymes)

 Disorder of digestive enzyme  maldigestion 

malabsorption
Disorders of
carbohydrate
assimilation
  Dissacharides  monosaccharides by specific enzymes
 Normal  all free mono- & disaccharides are
completely absorbed.
Lactose  Unabsorbed CHO  fermented in the colon by bacteria
 production CO2, H, methane, proprionic & butyric
intolerance acids
 CHO malabsorption  colonic fermentation & diarrhea
 small vol diarrhea + low quantities of fecal
electrolytes
  Congenital
 Rare
 Symptom  1st 3 month, colic
Lactose  Primary late onset
 Autosomal recessive, gradual reduction of lactase
intolerance: activity after 2 yr
type  Secondary
 Concomitant condition  infectious, allergic, &
inflammatory condition
  Nausea
Lactose  Crampy abdominal pain
intolerance:  Distention
clinical  Excessive flatulence
manifestation  Diarrhea (30 min following the ingestion of lactose)
  Diagnosis is suggested by the resolution of clinical
symptoms when subjects are placed on a strict lactose
elimination diet for 2 wks, and the recurrence of
symptoms once lactose is reintroduced.
Lactose  Stool test:
 pH < 5.3
intolerance:
diagnostic  Lactose breath test
 Rapid, non invasive
criteria  Sn 70-100%, Sp 100%
 Small bowel biopsies if high suspicion for 2nd LI with
diarrhea lasting > 4 wks
Lactose  Lactose free or lactose poor diet
intolerance:
treatment
  The syndrome of maldigestion resulting from disorders interfering
Pancreatic with effective pancreatic enzyme activity.
Insufficiency
Pancreatic
Insufficiency:
Etiology
Pancreatic
Insufficiency:
Clinical  Pancreatic lipase ↓  fat malabsorption
Manifestations  Steatorrhea: voluminous/bulky, foul smelling, greasy,
frothy, pale yellow, & floating
 Hidroxylated FA  inhibit Na & water absorption by the
colon  diarrhea
Protein
maldigestion
LITERATURE
McPhee S.J., Ganong W.F. Pathophysiology of disease: an introduction to clinical medicine. 5th ed.
Yamada T. Textbook of gastroenterology. 5th ed.
Vandenplas Y. Lactose intolerance. Asia Pac J Clin Nutr 2015;24(Suppl 1): S9-S13