Effects of decreasing intraluminal amylase activity on starch digestion and postprandial gastrointestinal function in humans

We used an amylase inhibitor preparation that markedly improves postprandial carbohydrate tolerance in humans to investigate the effects of decreased intraluminal amylase activity on digestion of starch and postprandial gastrointestinal and hormonal responses. Four fasting volunteers were intubated with an oroileal tube to obtain duodenal, jejunal, and terminal ileal samples. After intubation, subjects ingested 50 g of rice starch given with placebo; on the second day, starch was given with the amylase inhibitor. Compared with placebo, the amylase inhibitor significantly (p < 0.05) (a) reduced duodenal, jejunal, and ileal intraluminal amylase activity by more than 95% for 1-2 h; (b) increased postprandial delivery of total carbohydrate (glucose polymers in particular) to the distal small bowel; (c) increased breath hydrogen concentrations; (d) decreased intestinal water absorption and increased distal intestinal volume delivery to the distal bowel; (e) shortened duodenoileal transit time but doubled postprandial gastric emptying time; (f) reduced the early postprandial plasma glucose rise by 85% and eliminated the late postprandial glucose fall to below fasting levels; and (g) abolished postprandial plasma concentrations of insulin, C-peptide, and gastric inhibitory polypeptide. Postprandial trypsin output was not influenced. We conclude that more than 95% inhibition of amylase reduces dietary starch digestion within the small intestine and uptake of dietary starch from the small intestine, markedly decreases postprandial release of insulin and gastric inhibitory polypeptide, and may alter postprandial upper gastrointestinal motor function.