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Effects of a proton-pump inhibitor in cystic fibrosis
T M Tran1, A Van den Neucker, J J Hendriks
1Department of Pediatrics, University Hospital of Maastricht, The Netherlands.
Insights
Proton-pump inhibitors like lansoprazole can improve fat absorption in cystic fibrosis (CF) patients. This study shows lansoprazole reduces steatorrhoea and enhances growth and nutritional status in children with CF.
Area of Science:
- Pediatric Gastroenterology
- Cystic Fibrosis Research
- Gastrointestinal Pharmacology
Background:
- Cystic Fibrosis (CF) is a genetic disorder affecting multiple organs, notably the pancreas.
- Steatorrhoea (fat malabsorption) persists in many CF patients despite pancreatic enzyme replacement therapy (PERT).
- Low duodenal pH is hypothesized to impair pancreatic enzyme function, contributing to persistent steatorrhoea.
Purpose of the Study:
- To evaluate the efficacy of lansoprazole, a proton-pump inhibitor (PPI), in reducing steatorrhoea.
- To assess the impact of lansoprazole on growth parameters and nutritional status in pediatric CF patients.
- To determine if lansoprazole improves fat absorption and overall nutritional markers in CF patients with persistent steatorrhoea.
Main Methods:
- A cohort of 15 pediatric cystic fibrosis patients with persistent steatorrhoea on PERT was studied.
- Lansoprazole (15 mg/day) was administered for 3 months, with assessments before, during, and 3 months after treatment.
- Measurements included acid steatocrit (for steatorrhoea), anthropometry, dual-energy X-ray absorptiometry (DXA) for body composition, and nutritional status Z-scores.
Main Results:
- Acid steatocrit significantly decreased, indicating reduced fat malabsorption (p=0.02).
- Significant improvements in weight and height Z-scores were observed during lansoprazole treatment (p=0.02 and p=0.03, respectively).
- Improvements in skinfold thickness, fat mass, and bone mineral content were also significant (p<0.01). Nutritional status deteriorated after treatment cessation.
Conclusions:
- Lansoprazole demonstrates significant efficacy as an adjuvant therapy in managing steatorrhoea in cystic fibrosis patients.
- The addition of lansoprazole improves nutritional status, growth parameters, and body composition in CF children.
- These findings suggest that PPIs can be a valuable therapeutic option for CF-related fat malabsorption.
Abstract:
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 +/- SD acid steatocrit values decreased from 37.1 +/- 8.8% to 28.5 +/- 10.6% (p = 0.02). Significant mean Z-score improvements were found for weight (+0.14; p = 0.02), height (+0.15; p = 0.03), subscapular (+0.61; p = 0.003), supra-iliac (+0.8; p = 0.002) and the sum of the four measured skinfolds (+0.61; p = 0.002). Z-scores deteriorated again after stopping lansoprazole. Fat mass and bone mineral content increased significantly on lansoprazole (p = 0.008 and p = 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.