Petersen Karl-Uwe
Dig Dis. 2018;36(2):98-105. doi: 10.1159/000481399. Epub 2017 Oct 5.
Functional dyspepsia is a heterogeneous disorder lacking an established therapeutic strategy. Historical treatment attempts with pepsin products were shrugged off, as a simple calculation shows that quantitative substitution is pointless. However, such attempts might have been right for the wrong reason.
Today, the role of pepsins is primarily seen in the provision of signalling amino acids (especially phenylalanine and tryptophan) and peptides, which initiate processes promoting digestion. Proteolysis benefits from pepsin variants showing, contrary to common belief, activities of up to a pH value of 5.0. Non-clinical and clinical studies support the view that liberated amino acids produce a variety of direct and indirect effects. Signal chains stimulated by (mostly aromatic) amino acids lead to secretion of gastrin and cholecystokinin (CCK), mediated, respectively, by CCK2 (gastrin) and Ca2+-sensing receptors in the parietal cell, and Ca2+-sensing receptors in the antral and duodenal mucosa. Thus, CCK effects such as secretion of pancreatic enzymes and promotion of gastric accommodation are (also) consequential to peptic liberation of amino acids. Key Message: As functional dyspepsia represents a heterogeneous disorder, it may be intriguing to view pepsin as a potential (although still to be proven) treatment modality, distinguished by a diversity of pro-digestive effects.
功能性消化不良是一种异质性疾病，缺乏既定的治疗策略。以往使用胃蛋白酶产品的治疗尝试被忽视了，因为简单计算表明定量替代毫无意义。然而，这些尝试可能出于错误的原因却是正确的。
如今，胃蛋白酶的作用主要体现在提供信号氨基酸（尤其是苯丙氨酸和色氨酸）和肽，这些物质启动促进消化的过程。与普遍看法相反，胃蛋白酶变体在高达pH值5.0时仍具有活性，这有利于蛋白水解。非临床和临床研究支持这样的观点，即释放的氨基酸会产生多种直接和间接影响。由（大多为芳香族）氨基酸刺激的信号链分别通过壁细胞中的CCK2（胃泌素）和钙敏感受体以及胃窦和十二指肠黏膜中的钙敏感受体介导，导致胃泌素和胆囊收缩素（CCK）的分泌。因此，CCK的作用，如胰腺酶的分泌和胃容纳功能的促进，（也）是氨基酸消化释放的结果。关键信息：由于功能性消化不良是一种异质性疾病，将胃蛋白酶视为一种潜在的（尽管仍有待证实）治疗方式可能很有趣，其特点是具有多种促进消化的作用。
