Gastrointestinal Function and Nutrition

Notes on a talk by Dr. Giulio Barbero, M.D.

Fall 1994

Dr. Giulio Barbero, Professor in the Department of Child Health, University of Missouri at Columbia, re-emphasized the need to simplify the therapeutic regime that people with chronic illness must follow in order to stay well. Barbero spoke of the recent recall of enzymes with lipase units exceeding 20,000, and he felt that it was an overreaction on the part of the FDA. He said it especially made life more difficult for teens and adults (all the cases of strictures occurred in children) who now have to take a larger number of lower dosage enzymes. In cases where strictures had occurred, he pointed out that the individuals were on an excessively high dosage of enzymes and that these excessive dosages do not give a higher benefit. Barbero also downplayed the emphasis on when enzymes should be taken. He displayed the results of a study showing no significant difference in fat absorption between taking enzymes before the meal and taking them during it. So again, simplify! You don't have to disrupt the enjoyment of a meal to administer enzymes again and again.

Beyond the pancreas and enzymes, Barbero talked about the important role the intestines play in someone with CF. Different kinds of obstruction syndromes that can occur in the intestines include Meconium ileus, which occurs at birth in 5-10% of the CF population, Meconium ileus equivalent, Psuedomeconium ileus, and Distal Intestinal Obstruction Syndrome (DIOS), which occurs in 6-41% of CF patients. Effects of DIOS include abdominal pain (6-38% of cases), delayed bowel movements (30%), right lower abdominal fecal mass (4-14%), acute intestinal obstruction (1-2%), appendicitis (1%), and intussusception (1-2%). Obviously, food has different rates of transit through the GI tract of the CF individual. Therefore dietary patterns, especially copious consumption of water, is critical. Barbero stated that obstructions were usually precipitated by a decrease or cessation in enzyme intake, low fluid intake, high environmental heat exposure, sudden changes in diet, acute respiratory exacerbations and/or immobilization. Treatment to alleviate the obstruction includes a gastric lavage solution administered orally or through a nasal-gastric tube, and in severe cases, surgery.

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