The role of pancreatic exocrine insufficiency in the etiology of patients with functional dyspepsia

Objective: Dyspepsia affects 25% of the adult population at some point in their lives. When most of the patients examined for dyspepsia, an organic cause cannot be found and they are dıagnosed with functional dyspepsia(FD). FD is an important cause of morbidity affecting the quality of life of a large part of the population. Pancreatic Enzyme Deficiency (PEI) is a clinical condition that causes many gastrointestinal system complaints and should be considered in the differential diagnosis of dyspepsia. Acid-reducing treatments, prokinetic agents and anxiolytic agents are used when necessary in the treatment of FD. In our study, the frequency of PEI was determined by measuring the FE-1 (fecal elastase-1) levels in patients followed up for FD resistant to standard therapy, and the demographic, anthropometric, clinical and biochemical characteristics of these patients were compared with the control group. Materials and Methods: Those who applied to our clinic and were resistand to standard dyspepsia treatment for at least 4 weeks; FE-1enzyme levels, anthropometric, demographic, clinical and biochemical characteristics of 66 patients with FD and 34 volunteers without gastrointestinal system complaints, whose organic pathologies were excluded by endoscopy and imaging methods, were evaluated. Results: PEI was detected in 5(7.57%) of the 66 patients with FD included in the study, while PEI was not found in the volunteers (n=34). When the FE-1 levels between two groups were compared, it was found to be lower in the FD group (p=0.043). Diabetes Mellitus was found to be more common in patients with FD than in patients without PEI (p=0.048). When the symptoms of patients with FD were examined, it was shown that the complaints of diarrhea, sticky and foul-smelling stools were more common in patients with PEI (respectively; p=0.022, p=0.001, p=0.004). Calcium, phosphorus and magnesium values were found to be lower in patients with PEI compared to the control group (respectively; p=0.018, p=0.011, p=0.001). Conclusion: Unless suspected, delays may occur in the diagnosis of PEI, which is one of the organic causes of dyspepsia that affects a significant part of the society. PEI can be diagnosed and treated with detailed anamnesis and diagnostic methods. In patients with dyspepsia resistant to standard therapy, if diarrhea, sticky and foul-smelling stools accompany symptoms, they should be evaluated for PEI. Large-scale, randomized and controlled long-term prospective studies are needed to better understand the relationship between PEI and FD.