The FODMAP diet and the cytoprotector rebamipid increase the activity of carbohydraz in patients with enteropathy with impaired membrane digestion

Aim. To show a change in the activity of the mucous membrane of the small intestine enzymes in patients with EWIMD under the influence of a cytoprotector (rebamipid) and a low-FODMAP diet; to assess the quality of life of patients with enteropathy with impaired membrane digestion (EWIMD) with various treatment regimens.

Materials and methods. Eighty four patients with clinical symptoms of EWIMD were examined. Each patient had a biopsy taken from the bulbous part of the duodenum. Enzymes of the mucous membrane of the small intestine were studied: glucoamylase, maltase, sucrose, lactase. Enzyme activity was determined by the Dahlquist method modified by N.I. Belostotsky. Each patient filled out the SF-36 questionnaire after completing the therapy stage. The indicators of physical and social functioning (PF and SF), vital activity (VA), emotional well-being (EW), pain level (PL) were studied.

Results. When studying the activity of the mucous membrane of the small intestine enzymes in patients before treatment, it was revealed that the average value of glucoamylase was 104 ng glucose/mg of tissue, maltase – 564, sucrose – 49.6, lactase – 13.2. After 4 weeks of rebamipid therapy, an increase in glucoamylase from baseline values (before treatment) was 1.8 times (p<0.005), maltase 1.4 times (p<0.005), sucrose 1.3 times (p<0.005), lactase 1.5 times (p=0.13). After 8 weeks, a further increase in their activity was detected: glucoamylase increased 2.2 times (p<0.005), maltase 1.8 times (p<0.005), sucrose 1.7 times (p=0.021). The exception was lactase, the activity of which increased 1.3 times (p=0.449), compared with the baseline data, in contrast to the 4-week course of therapy. After 12 weeks of rebamipid therapy, glucoamylase increased 3.2 times (p<0.005), maltase 3 times (p<0.005), sucrose 2.9 times (p<0.005), and lactase 1.9 times (p=0.097). When studying the activity of enzymes under the influence of the low-FODMAP diet, an increase in the activity of glucoamylase by 2.1 times (p<0.005), maltase by 1.7 times (p<0.005), sucrose by 2.06 times (p<0.005), lactase by 2.22 times (p<0.005) was noted. When examining the questionnaire data before the start of treatment, a decrease in VA and EW was revealed (the average values were 44.7 and 50.5, respectively), VA was pronounced (46.58), while the level of PF and SF was satisfactory (78.8 and 62, respectively). After 4 weeks of rebamipid therapy, there was an improvement in all studied indicators. Thus, the level of PF and SF increased to 86 and 78.8, respectively (p<0.005), decreased VA to 64.9 (p<0.005), there was a tendency to increase in VA and EW (56.3 and 59.73, respectively; p<0.005). After 8 weeks, the improvement trend continued. The level of FF and SF reached almost maximum values (98.3 and 92.9, respectively; p<0.005), PL continued to decrease (82.2; p<0.005), the indicators of VA and EW continued to grow (69.1 and 65.3, respectively; p<0.005). After 12 weeks of rebamipid therapy, the maximum values were recorded. Thus, FF and SF were fully restored (100 and 99.16, respectively; p<0.005), almost none of the patients recorded pain sensations – the PL reached 100 (p<0.005). There were also good indicators for VA and EW (79.83 and 75.3, respectively; p<0.005). Under the influence of the low-FODMAP diet, the quality of life level corresponded to the 8-week course of rebamipid (PF – 97, SF – 86.23, PL – 80.6, VA – 66.83, EW – 69.2; p<0.005).

Conclusion. Rebamipid at a dose of 300 mg/day consistently increases the activity of carbohydraz the mucous membrane of the small intestine after 4, 8 and 12 weeks of therapy. When following the low-FODMAP diet for 8 weeks, an increase in enzyme activity is also noted. The most pronounced improvement in the quality of life is recorded against the background of 12 weeks of rebamipid therapy.