Gastric emptying and intestinal transit of pancreatic enzyme supplements in cystic fibrosis

Abstract

Objective-To investigate gastric emptying and intestinal transit of pelleted pancreatin in relation to food boluses. Methods-Dual isotope scintigraphy combined with breath hydrogen sampling was used to track the concurrent gastric emptying and intestinal transit of 111 indium labelled microspheres and a 99m technetium labelled tin colloid test meal. Twelve pancreatic insuYcient cystic fibrosis patients aged 5 to 38 years performed the study. Results-50% gastric emptying times showed patient to patient variation. The mean discrepancy in 50% gastric emptying times between the two labels was > 67 minutes. Mean small bowel transit time for the food bolus was prolonged at 3.6 minutes. A significant correlation was seen between weight standard deviation score and 50% emptying time for pancreatin (r = +0.73). Conclusion-Gastric mixing of food and pancreatin may be limited by rapid emptying of microspheres. Patients with high dosage requirements could benefit from changing the pattern of their pancreatin supplementation.

Diagnosis and Treatment of Intestinal Malabsorption in Cystic Fibrosis

“…Presumably the many differences in pharmacological characteristics may be relevant to their differing performance in practice, including their quantitative and qualitative enzyme content, 95 dissolution characteristics, 60 and size of the particles. 61,62 The individual differences in dose requirements, even in patients with little or no residual pancreatic function, are presumably due, in part, to these brand differences.…”

Cystic fibrosis related diabetes—a new perspective on the optimal management of postprandial glycemia

“…The relationship between gastric emptying of nutrients and supplemental enzymes is complex, and co-ordination of both to optimise nutrient absorption is therapeutically challenging, particularly when gastric emptying is disordered (either abnormally fast or slow) [33,34]. It is recognised that there is substantial interindividual variation in gastric emptying of food and enzymes respectively, with enzymes empting on average 60 minutes before food when given together [35].…”

Routine OGTT screening for CFRD - no thanks

“…Thus, over time, the potential of the pancreas to perform its endocrine function diminishes: this relative insulinopenia may be accompanied by insulin resistance in the liver. 15 However, the effects of these changes in glucose handling are very variable, and can be affected by stress, infection and the altered bowel function (including transit time) 28 that occurs in all CF individuals with exocrine pancreatic disease. Since this glucose intolerance is a dynamic process, it is apparent that single point tests (including the OGTT) will not give an accurate picture of overall glucose handling in CF.…”