Effects of a proton‐pump inhibitor in cystic fibrosis

Abstract

Tran TMD, Van den Neucker A, Hendriks JJE, Forget P, Forget P-Ph. Effects of a proton-pump inhibitor in cystic fibrosis. Acta Paediatr 1998; 87: 553-8. Stockholm. ISSN 0803-5253 Most children with cystic fibrosis (CF) show persisting steatorrhoea even when treated with pancreatic enzyme. As a low duodenal pH could be responsible for this persisting fat loss, we evaluated the effects of a proton-pump inhibitor (lansoprazole) on both steatorrhoea and growth parameters in 15 CF patients, aged 3.1-22.6 y. Acid steatocrit, anthropometry and dual-energy X-ray absorptiometry were used to evaluate steatorrhoea and the nutritional status before, during and 3 months after stopping lansoprazole treatment (15 mg/d for 3 months). Mean Ϯ SD acid steatocrit values decreased from 37.1 Ϯ 8.8% to 28.5 Ϯ 10.6% ( p ¼ 0:02). Significant mean Z-score improvements were found for weight (þ0:14; p ¼ 0:02), height (þ0:15; p ¼ 0:03), subscapular (þ0:61; p ¼ 0:003), supra-iliac (þ0:8; p ¼ 0:002) and the sum of the four measured skinfolds (þ0:61; p ¼ 0:002). Z-scores deteriorated again after stopping lansoprazole. Fat mass and bone mineral content increased significantly on lansoprazole ( p ¼ 0:008 and p ¼ 0:005, respectively). We conclude that lansoprazole as adjuvant therapy significantly improves both steatorrhoea and the nutritional status in CF children who maintain steatorrhoea while on pancreatic enzymes. ٖ Acid steatocrit, cystic fibrosis, nutritional condition, proton-pump inhibitor P-Ph Forget,

Esomeprazole Increases Airway Surface Liquid pH in Primary Cystic Fibrosis Epithelial Cells

“…PPIs serve to reduce acid reflux but also compensate for the lack of gastrointestinal secretion (due to defective CFTR), and thereby enhance the benefit of pancreatic enzyme replacement therapy. Indeed, several studies have shown the beneficial effect of PPI use in children with CF when looking at steatorrhea and nutritional status (Tran et al, 1998; Proesmans and De Boeck, 2003), and it is well acknowledged that in these cases, PPIs such as omeprazole and lansoprazole, show improvement in fat absorption. However, the effect of PPI on pulmonary function is more controversial.…”

Pancreatic insufficiency in Cystic Fibrosis

“…This has led to speculation that bile acids, crucial for mixed micelle formation, may precipitate in the CF intestine [61]. Acid suppression, usually with proton pump inhibitor, has been suggested to improve bile salt availability and thus, absorption [62][63][64][65][66][67]. There is no clear evidence supporting the use of proton pump inhibitors in this context.…”

Use and Incidence of Adverse Effects of Proton Pump Inhibitors in Patients with Cystic Fibrosis

“…Patients with CF may also take a PPI as adjuvant therapy with pancreatic enzymes to improve nutritional status. One study found that treating patients with CF with a PPI reduced steatorrhea and improved nutritional status by increasing duodenal pH . Increased duodenal pH allows for enhanced pancreatic enzyme release and increased lipase activity.…”