# The Role of Pancreatic Enzyme Insufficiency in the Etiology of Functional Dyspepsia Resistant to Standard Treatment

## TL;DR

This study found that pancreatic enzyme insufficiency may be a hidden cause in some patients with treatment-resistant functional dyspepsia.

## Contribution

The study highlights PEI as an underrecognized cause of FD unresponsive to standard therapies.

## Key findings

- PEI was found in 7.57% of treatment-resistant FD patients but not in healthy controls.
- Diabetic FD patients had a significantly higher prevalence of PEI.
- Low serum calcium, phosphorus, and magnesium levels were observed in PEI patients.

## Abstract

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.