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Updated: Sep 22, 2025
Rectal Organoid Morphology Analysis ROMA: A Diagnostic Assay in Cystic Fibrosis
Published on: June 10, 2022
Association between stool consistency and clinical variables among infants with cystic fibrosis: Findings from the
A Jay Freeman1, Rong Huang2, Sonya L Heltshe3
1Associate Professor, Division Gastroenterology, Hepatology and Nutrition, Children's Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, GA, USA.
Insights
Stool patterns in infants with cystic fibrosis (CF) evolve similarly to healthy infants. Constipation in CF infants is not linked to pain and is less common with acid suppression or formula feeding.
Area of Science:
- Pediatric Gastroenterology
- Cystic Fibrosis Research
- Infant Health
Background:
- Stool consistency concerns are frequent in infants with cystic fibrosis (CF).
- Normal stool patterns for infants with CF remain undescribed.
- Understanding typical stool characteristics is crucial for CF infant care.
Purpose of the Study:
- To describe normal stool patterns in infants with CF during their first year of life.
- To investigate factors influencing stool consistency and frequency in CF infants.
- To establish a baseline for identifying abnormal stool patterns in CF.
Main Methods:
- Secondary analysis of the BONUS cohort (231 infants with CF).
- Data collected at 3, 6, and 12 months included stool characteristics, feeding type, and medications.
- Statistical analyses included repeated measure ANOVA and generalized linear mixed models.
Main Results:
- Constipation frequency remained stable (10-13%) throughout the first year.
- Watery stools decreased significantly from 21.3% at 3 months to 5.8% at 12 months.
- Exclusive breastfeeding increased constipation risk (OR=2.64), while formula feeding (OR=0.40) and acid suppression (OR=0.59) decreased it.
Conclusions:
- Stool frequency and consistency in CF infants evolve similarly to non-CF infants.
- Constipation in CF infants is not associated with pain.
- Acid suppression and exclusive formula feeding are associated with reduced constipation risk in CF infants.
Background:
Concerns related to stool consistency are common in the first year of life among children with cystic fibrosis (CF). However, normal stool patterns for infants with CF have not been described.
Methods:
Secondary analysis was completed from the previously described BONUS cohort which followed 231 infants with CF through the first 12 months of life. Pain, stool category, stool frequency, feeding type, PERT dose, acid suppression medication, antibiotics usage, stool softener usage and fecal calprotectin were described at 3, 6, and 12 months. Repeated measure ANOVA was used to test the difference in mean stool number. Generalized linear mixed models were used to investigate the relationship between stool characteristics and various factors.
Results:
The frequency of constipation was stable throughout the first year of life (10-13%) while watery stool significantly decreased from 21.3% at 3 months to 5.8% at 12 months (p=<0.001). The number of stools at months 6 (mean=2.40) and 12 (mean=2.50) are significantly lower than in month 3 (mean=2.83), p<0.025. Exclusive breast feeding was associated with an increased risk for constipation (OR=2.64 [1.60-4.37], p = 0.002) while exclusive formula feeding and acid suppression was associated with decreased risk for constipation (OR=0.40 [0.26-0.61], p=<0.0001 and OR=0.59 [0.39-0.89], p = 0.01 respectively). Pain was not significantly associated with stool consistency.
Conclusion:
Stool frequency and consistency evolves in infant with CF in a fashion similar to that reported in non-CF infants over the first year. Constipation was not associated with pain and was less common among infants receiving acid suppression or exclusively formula feeding.
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