Amylorrhea is the appearance of a large number of starch grains in the feces, which indicates a violation of the digestion of carbohydrates. The symptom occurs with enzyme deficiency – chronic pancreatitis, enteritis, pancreatic tumors. Amylorrhea is observed with increased peristalsis, which happens with IBS, intestinal infections, hyperacid gastritis. The diagnostic plan involves carrying out functional probe and non-probe methods, coprogram, instrumental visualization of the pancreas. Treatment includes diet therapy, pancreatic enzyme preparations, antacids and probiotics.
Causes of amylorrhea
Irritable bowel syndrome
The appearance of the symptom is possible with IBS with a predominance of diarrhea. Amylorrhea is caused by increased intestinal motility, as a result of which digestive enzymes do not have time to act on carbohydrates. It manifests itself as a liquid stool of yellow or light brown color with an unpleasant pungent odor. Before defecation, spastic abdominal pain increases, after emptying the intestine, it decreases or disappears completely.
Amylorrhea in poisoning is caused not only by the activation of peristalsis, but also by the direct toxic effect of pathogenic microorganisms on the wall of the small intestine. The symptom is more typical for the onset of the disease when there is a sufficient amount of partially digested food in the stomach and intestines. Diarrhea occurs, the frequency of which depends on the severity of the intestinal infection. Fecal masses are liquid, have a bright yellow, orange or greenish tint.
The appearance of amylorrhea is caused by two mechanisms: inactivation of saliva amylase in the acidic environment of the stomach and accelerated progress of chyme due to the irritating effect of acid on the small intestine. Stool disorders are associated with errors in the diet — the use of large amounts of complex carbohydrates. There is one- or two-fold diarrhea with the release of liquid fetid feces. Amylorrhea is accompanied by abdominal cramps, epigastric pain.
With inflammation of the pancreas, signs of amylorrhea are relatively rare, which is explained by the high enzymatic activity of intestinal amylase. The condition is more often noted in advanced forms of the disease. Amylorrhea occurs when the diet mainly consists of carbohydrate foods. A person is worried about severe flatulence and pain in the epigastric region. Then there is an unformed fetid stool, in which there may be particles of undigested food.
When following a diet, amylorrhea disappears. Chronic pancreatitis is characterized by a sequence of changes in the composition of fecal masses. First, steatorrhea occurs, as evidenced by grayish soft feces with a greasy sheen. Later creatorrhea joins, amylorrhea develops in the later stages of the disease. The symptom is also typical for a complication of pancreatitis – pancreatic fibrosis.
Enzyme insufficiency of the pancreas
Violation of the exocrine function of the organ is accompanied by a decrease in the production and release of pancreatic amylase into the small intestine. In the initial stages, the condition is compensated by intestinal enzymes, but in the advanced stages of the disease, amylorrhea may begin. It has typical clinical manifestations specific to the chronic form of pancreatitis. The main causes of external secretory pancreatic insufficiency:
- Congenital pathologies: genetic enzyme deficiency, pancreatic agenesis or hypoplasia, Schwachman-Diamond syndrome.
- Volumetric formations: stagnant, tumor and parasitic cysts, pancreatic cancer.
- Postoperative complications: during operations on the stomach, small intestine, pancreatic gland.
With an inflammatory lesion of the wall of the small intestine, the release of enzymes is disrupted, the processes of abdominal and parietal digestion are inhibited. Undigested carbohydrates in the form of starch move into the large intestine, enhance peristalsis and increase the watery fecal masses. Therefore, with amylorrhea, multiple diarrhea occurs. The stool has a liquid consistency or stands out in separate soft lumps.
Complications of pharmacotherapy
Amylorrhea is provoked by an overdose of laxatives that affect intestinal motility. As a result, a person develops diarrhea. Food passes quickly through the digestive tract and does not have time to completely split. Fecal masses are abundant, liquid, have a sharp unpleasant smell. Amylorrhea is combined with cramps and abdominal discomfort, flatulence. After 12-24 hours, the effect of the drugs ends, the condition normalizes.
During an external examination, a gastroenterologist pays attention to the body weight deficit of a patient with amylorrhea. Dryness and peeling of the skin, brittle nails, and congestion are often detected, which indicates vitamin deficiency. It turns out the frequency and nature of the stool, the peculiarities of nutrition, against which the symptoms appeared. Laboratory and instrumental methods are used to determine the causes of amylorrhea:
- Stool tests. The coprogram shows an increased content of starch grains, neutral fats and undigested muscle fibers. To clarify pancreatic functions, the level of fecal elastase is measured. In case of a possible intestinal infection, as the cause of amylorrhea, fecal backfitting is indicated.
- Functional tests. To assess the enzymatic activity, probe and non-probe methods are performed. The pathology of the organ, manifested by amylorrhea, is evidenced by an insufficient increase in the volume of secretions and the level of bicarbonates after drug stimulation. As a screening method, a blood test for amylase, lipase is performed.
- Instrumental visualization. To study the structure, contours and echogenicity of the organ, an ultrasound of the pancreas is performed. For a more detailed study of the parenchyma, a patient with amylorrhea needs an MRI. Selective angiography is informative to exclude malignant neoplasms. The state of the pancreatic ducts is examined using ERCP.
- Fibrogastroduodenoscopy. The technique is recommended for suspected hyperacid gastritis, provoking amylorrhea. With EGD, specific inflammatory changes of the gastric wall, erosion are noticeable, sometimes ulcerative defects are detected. Intragastric pH-metry is performed to change the level of hydrochloric acid secretion.
- Biopsy. Invasive examination with the collection of pancreatic tissue samples is necessary to assess the degree of fibrosis and destruction of parenchyma, to identify damage to the insulin apparatus in amylorrhea sufferers. The biopsy technique is very important for understanding the prognosis of the disease, the choice of treatment tactics.
Help before diagnosis
Regardless of the cause of amylorrhea, the first step in eliminating symptoms is diet therapy. It is recommended to have a balanced protein-energy diet with a high content of vitamins. Preference is given to easily digestible food that does not cause functional overload of the digestive organs, reduces or completely eliminates amylorrhea. A prerequisite is quitting smoking, since nicotine reduces the synthesis of bicarbonates and promotes acidification of the medium of the small intestine.
To combat amylorrhea, enzyme preparations are effective. They are dosed according to the amount of lipase, since its secretion is disrupted in the first place. Effective medicines are selected in microgranular form, which are resistant to the action of gastric juice and provide rapid release of enzymes. In amylorrhea , in addition to replacement therapy , a number of drugs are prescribed after confirmation of the diagnosis:
- Probiotics. The funds are aimed at normalizing the intestinal biocenosis, reducing fermentation processes. They eliminate the phenomena of diarrhea, reduce flatulence, improve digestion, thus reducing amylorrhea. To enhance the effect, probiotics are combined with prebiotics.
- Antisecretory drugs. They are used for gastritis with high acidity and amylorrhea. Proton pump inhibitors, H2-histamine blockers are used. Medications quickly normalize the secretion of hydrochloric acid, slow down gastric and intestinal peristalsis.
- Antacids. Medicines are recommended for the treatment of diarrhea combined with amylorrhea. They have an astringent effect, neutralize the irritating effect of hydrochloric acid on the intestinal wall. With a stool multiplicity of about 10 or more times a day, special antidiarrheal medications are indicated.
- Insulin. Substitution therapy is advisable in case of concomitant violation of the endocrine function of the pancreas. The dosage and frequency of administration are selected individually, taking into account the level of glucose in the blood, glucose tolerance test indicators, the severity of amylorrhea.
- Vitamins. Injectable vitamin medications are administered with an advanced form of pancreatitis with impaired absorption of all nutrients. Magnesium, copper, and zinc preparations are used to correct the electrolyte composition of the blood in amylorrhea.
With severe organ atrophy, surgical interventions are carried out in specialized centers. Langerhans islets are transplanted to patients with subsequent removal of the gland. Such treatment requires lifelong enzyme replacement therapy. In case of malignant neoplasms, a radical operation is performed — pancreatoduodenal resection or resection of the pancreas with preservation of the pyloric zone and the duodenum 12.