Does Pepticon (proteolytic enzyme) Double Action help with bloating?

Does Pepticon (Proteolytic Enzyme) Help with Bloating?

No, there is no evidence that Pepticon or proteolytic enzymes effectively treat bloating, and current gastroenterology guidelines do not recommend enzyme supplementation for functional bloating disorders.

Evidence-Based Treatments for Bloating

The provided evidence focuses exclusively on established therapies for bloating, none of which include proteolytic enzymes. The most effective treatments are:

First-Line Interventions

Dietary modifications should be attempted first, including:

• A short-term (2-week) low FODMAP elimination diet to identify fermentable carbohydrate triggers 1
• Testing for and restricting specific carbohydrate intolerances (lactose, fructose, sorbitol), with fructose intolerance affecting approximately 60% of patients with digestive disorders 1
• Avoiding artificial sweeteners and sugar alcohols 1

Behavioral therapies provide immediate relief:

• Diaphragmatic breathing techniques reduce vagal tone and correct paradoxical diaphragm contraction that worsens distention 2, 1
• Cognitive behavioral therapy (CBT) and gut-directed hypnotherapy show robust evidence for improving bloating symptoms 1

Second-Line Pharmacological Treatments

When first-line therapies fail, central neuromodulators are the most effective option:

• Low-dose tricyclic antidepressants (amitriptyline starting at 10 mg, titrating to 30-50 mg) reduce visceral hypersensitivity, with 61% of patients reporting response for bloating 3, 4
• These work by improving disrupted brain-gut control mechanisms and reducing the abnormal viscerosomatic reflex that triggers distention 3, 4

For bloating with constipation specifically:

• Secretagogues (lubiprostone, linaclotide, plecanatide) or prucalopride are superior to placebo with a number needed to treat of 8 for moderate-severe bloating improvement 1, 4

What Does NOT Work

Prokinetic agents like domperidone should not be used:

• The American Gastroenterological Association does not recommend domperidone for bloating due to lack of efficacy evidence 4
• Domperidone carries significant cardiac risks including QT prolongation and sudden cardiac death, particularly at doses >30 mg/day 4

Why Proteolytic Enzymes Are Not Recommended

The comprehensive guidelines from the American Gastroenterological Association (2023) 2, British Society of Gastroenterology 3, and European Society of Gastroenterology 3 make no mention of proteolytic enzymes as a treatment for bloating. The pathophysiology of functional bloating involves:

• Visceral hypersensitivity and impaired central down-regulation of visceral signals 3
• Abnormal gas handling and abdominophrenic dyssynergia 1
• Bacterial fermentation of poorly absorbed carbohydrates 1

None of these mechanisms would be addressed by protein-digesting enzymes.

Clinical Algorithm for Bloating Management

1. Identify the pattern: bloating with constipation vs. diarrhea vs. functional bloating alone 4
2. Start dietary elimination: 2-week low FODMAP trial with breath testing if indicated 1
3. Add behavioral therapy: diaphragmatic breathing immediately, CBT or hypnotherapy for persistent symptoms 2, 1
4. For bloating + constipation: prescribe secretagogues (linaclotide, plecanatide) or prucalopride 4
5. For functional bloating without constipation: start amitriptyline 10 mg at bedtime, titrate to 30-50 mg over 6-8 weeks 3, 4
6. Evaluate for defecatory disorders: refer for anorectal biofeedback if pelvic floor dyssynergia is present 1, 4

Critical Pitfall

Do not waste time or money on unproven supplements like proteolytic enzymes when evidence-based treatments with demonstrated efficacy are available. The substantial placebo response seen in bloating trials (33-48% response rate) 5, 6 means patients may perceive benefit from any intervention, but this does not constitute evidence of true therapeutic effect.