Intestinal pH and Gastrointestinal Transit Profiles in Cystic Fibrosis Patients Measured by Wireless Motility Capsule

• Published in: Digestive diseases and sciences Vol. 58; no. 8; pp. 2275 - 2281
• Main Authors: Gelfond, Daniel, Ma, Changxing, Semler, Jack, Borowitz, Drucy
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.08.2013; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Biochemistry; Body mass index; Capsule Endoscopy - instrumentation; Cystic fibrosis; Cystic Fibrosis - metabolism; Enzymes; Female; Gastroenterology; Gastrointestinal Motility; Hepatology; Humans; Hydrogen-Ion Concentration; Intestines - chemistry; Male; Medicine; Medicine & Public Health; Oncology; Original Article; Pilot Projects; Transplant Surgery; Young Adult; Cystic fibrosis; PERT; pH profile; Small bowel transit; Wireless motility capsule; CFTR
• ISSN: 0163-2116; 1573-2568; 1573-2568
• DOI: 10.1007/s10620-012-2209-1

Background and Aims The effect of the cystic fibrosis transmembrane conductance regulator protein (CFTR) defect in pancreatic insufficient (PI) patients with cystic fibrosis (CF) on the gastrointestinal pH profile is poorly defined. Adequate and efficient neutralization of the gastric acidity in the duodenum is important for nutrient absorption and timely release of pancreatic enzyme replacement therapy (PERT). We utilized a wireless motility capsule (WMC) to study intestinal pH profile and gastrointestinal transit profile in CF subjects. Methods WMC studies were done on ten adult CF patients with PI while off acid suppression medication and ten age, gender and BMI matched healthy controls. Mean pH over 1 min increments and area under the pH curve over 5 min increments was calculated for the first hour post gastric emptying. Paired t-test was used to compare means of the pH recordings, transit profiles and analysis of time interval required to reach and maintain pH >5.5 and 6.0. Results A statistically significant difference was observed between mean pH values during the first 23 min of small bowel transit ( p  < 0.05). In CF subjects, there was a significant delay in time interval required to reach and sustain pH 5.5 and pH 6.0 ( p  < 0.001), which is required for PERT dissolution. Only small bowel transit in CF subjects was noted to be significantly delayed ( p  = 0.004) without a compensatory increase in whole gut transit time. Conclusions We have demonstrated a significant delay in the small intestinal transit and a deficient buffering capacity required to neutralize gastric acid in the proximal small bowel of patients with CF.