Regulating the digestion

If the doctor has not found any serious disorders, the patient can usually treat himself well with OTC (“over-the-counter”) preparations under the guidance of PTA or a pharmacist. Dyspeptic complaints are an established indication area for various medicinal plants. The European Cooperation for the Evaluation of Phytotherapeutics ESCOP, for example, confirmed the effectiveness of balm, peppermint and yarrow in the treatment of dyspepsia. Camomile extracts (for example Kamillosan®) and peppermint oil have a relaxing effect, caraway oil helps against flatulence. Bitter substance drugs are also classically used for the treatment of dyspepsia, such as condurango bark, turmeric, wormwood, cnicus (St. Benedict’s thistle) and bitter candytuft (Iberis). Liquid preparations of these medicinal plants trigger gustatory and olfactory stimuli.

These in turn activate a reflex which increases the production of gastric juices. In addition, there is an increased secretion of pancreatic enzymes and bile acids. In solid dosage forms, when the bitter substances cannot trigger gustatory stimuli, the effect is based exclusively on direct stimulation of the production of gastrin in the gastric mucosa. Herbal combination preparations are also suitable for the treatment of dyspepsia, for example combinations of peppermint and caraway oil (Carmenthin®) or of bitter candytuft, angelica root, camomile flowers, caraway, milk thistle fruits, lemon balm leaves, peppermint leaves, celandine and liquorice root (Iberogast®). There are clinical studies on artichoke extract preparations proving their effectiveness in the treatment of dyspeptic complaints if these are based on functional disorders of the bile ducts.

If there is an insufficient production of digestive enzymes in the pancreas, lipases, amylases and proteases can be substituted. In this context, lipases are of the greatest therapeutic importance, as the symptoms of pancreatic insufficiency are mainly due to impaired fat digestion. Lipases are the only digestive enzymes that are produced exclusively by the pancreas. This means that the body cannot compensate for an insufficient production elsewhere.

For the substitution, there is a choice between enzymes of animal and of plant origin. Pancreatin is a powdered extract from the pancreas of a pig (e.g. Pankreatan®, Ozym®), the plant enzymes come from rice fungus cultures: rizolipases are produced by Rhizopus oryzae, proteases and amylases by Aspergillus oryzae. A mixture of these fungal enzymes is contained in the preparation Nortase®.

The dosage of the enzyme preparations depends on the severity of the disease, the patient's body weight and the fat content of the respective meal. When dispensing the preparations, PTA and pharmacists should point out that they should be taken during meals. This is because the enzymes need to be well mixed with the chyme to be effective.

In the substitution of pancreatic enzymes, lipase is particularly important. Therefore, the number added to some preparation names, e.g. Kreon® 10.000, pancreatin STADA 20.000 or Panzytrat® 40.000, also refers to the lipase content. It indicates in units of the European Pharmacopoeia (Ph.Eur.units) the activity of the lipase contained. As a general reference dose, a lipase dose of 20.000 to 40.000 Ph.Eur. units per meal is recommended.

Some preparations for digestive disorders contain, in addition to pancreatin, dimethicone or simethicone (Meteozym®, Enzyme Lefax®). They are suitable for the treatment of dyspepsia, where flatulence is the main symptom.