Kemik Fatih, Ceylan Gozde, Aydin Abdurrahman F, Çavuş Bilger, Ormeci Asli, Imanov Ziya, Senkal Ibrahim V, Nuriyev Kenan, Istemihan Zulal, Akyuz Filiz, Besisik Selman F, Kaymakoglu Sabahattin, Demir Kadir
Department of Internal Medicine, İstanbul University İstanbul Medical School, İstanbul, Türkiye.
Department of Biochemistry, İstanbul University İstanbul Medical School, İstanbul, Türkiye.
Turk J Gastroenterol. 2025 Jun 16;36(7):467-473. doi: 10.5152/tjg.2025.24729.
BACKGROUND/AIMS: Functional dyspepsia (FD) is diagnosed in the absence of an identifiable organic cause. Pancreatic enzyme insufficiency (PEI) remains an underrecognized condition in these patients. This study aimed to investigate the prevalence of PEI among FD patients unresponsive to standard therapy and to evaluate its clinical and biochemical characteristics.
A total of 154 patients diagnosed with FD were followed, among which 66 patients who did not respond to at least 4 weeks of standard treatment, including acid-reducing therapies, prokinetics, and antidepressants, were evaluated. Additionally, 34 healthy volunteers were included as a control group. Organic pathologies were excluded in all 66 patients with FD resistant to standard treatment using endoscopy, endoscopic biopsy, and imaging methods. Fecal elastase-1 (FE-1) enzyme levels were measured to determine the prevalence of PEI in both groups.
Pancreatic enzyme insufficiency was detected in 5 (7.57%) of the 66 treatment-resistant FD patients, while none of the controls had PEI. The prevalence of PEI was significantly higher in diabetic patients than in non-diabetic patients within the study group (P = .037). Patients with diarrhea, sticky stools, and frequent foul-smelling stools exhibited a higher prevalence of PEI (P = .022, P = .001, and P = .004, respectively). In the study group, PEI patients had lower serum calcium, phosphorus, and magnesium levels than the control group (P = .018, P = .011, and P = .001, respectively).
Pancreatic enzyme insufficiency was identified in 7.57% of patients resistant to standard treatment. In patients resistant to standard therapy for at least 4 weeks, the presence of symptoms such as diarrhea, sticky stools, and foul-smelling stools, along with diabetes mellitus and low serum calcium, phosphorus, and magnesium levels, may warrant consideration of PEI as a potential underlying condition.
背景/目的：功能性消化不良（FD）是在没有可识别的器质性病因的情况下做出的诊断。胰腺酶不足（PEI）在这些患者中仍然是一种未被充分认识的病症。本研究旨在调查对标准治疗无反应的FD患者中PEI的患病率，并评估其临床和生化特征。
共随访了154例诊断为FD的患者，其中66例对至少4周的标准治疗（包括抑酸治疗、促动力药和抗抑郁药）无反应的患者接受了评估。此外，纳入34名健康志愿者作为对照组。使用内镜检查、内镜活检和影像学方法，在所有66例对标准治疗耐药的FD患者中排除了器质性病变。测量两组粪便弹性蛋白酶-1（FE-1）酶水平以确定PEI的患病率。
66例治疗耐药的FD患者中有5例（7.57%）检测出胰腺酶不足，而对照组无一例有PEI。在研究组中，糖尿病患者的PEI患病率显著高于非糖尿病患者（P = 0.037）。有腹泻、大便黏稠和频繁恶臭大便的患者PEI患病率较高（分别为P = 0.022、P = 0.001和P = 0.004）。在研究组中，PEI患者的血清钙、磷和镁水平低于对照组（分别为P = 0.018、P = 0.011和P = 0.001）。
在7.57%对标准治疗耐药的患者中发现了胰腺酶不足。在对标准治疗耐药至少4周的患者中，出现腹泻、大便黏稠和恶臭大便等症状，以及糖尿病和血清钙、磷、镁水平低，可能需要考虑PEI作为潜在的基础病症。
