The effects of cystic fibrosis on the pancreas
The pancreas creates enzymes, which are important chemicals that break down fats, proteins and carbohydrates in your food. This is important for releasing the nutrients that your body uses to make energy.
In digestion in people with CF, the small tubes that transport these enzymes out of the pancreas become blocked with mucus. The enzymes build up in the pancreas instead of reaching the digestive system (specifically, the lumen of the gut), causing the pancreas to become inflamed. As a result, people with CF have to take supplements to replace these enzymes with their meals to help digest their food. A person whose pancreas is affected in this way is suffering from ‘pancreatic insufficiency’.
Problems with the pancreas can also cause CF-related diabetes, which affects around a third of people with cystic fibrosis. Find out more about CF-related diabetes.
Owing to difficulties digesting fat, many people with cystic fibrosis require more fatty foods and a higher daily calorie intake than those without the condition, particularly if they are fighting an infection.
People with cystic fibrosis also often experience digestive symptoms such as:
- greasy and bulky stools
- frequent and/or difficult bowel movements
- swollen abdomen
- loss of appetite
Medication can help compensate for the failure of the pancreas, such as digestive enzymes (Creon®) that most people with cystic fibrosis take with each meal to help digest food. Find out more about nutrition in cystic fibrosis.
Meconium ileus (bowel obstruction) in cystic fibrosis
One in every ten babies born with cystic fibrosis develops a bowel obstruction called meconium ileus at birth or within the first few days of life. In these cases, the meconium (a thick black material present in the bowels of all new born babies) is so thick that it blocks the bowel instead of passing through.
Babies with meconium ileus often need an urgent operation to relieve and bypass the blockage.
Distal intestinal obstruction syndrome (DIOS) in cystic fibrosis
Previously known as meconium ileus equivalent (MIE), DIOS is a condition that is unique to cystic fibrosis. DIOS causes blockages in the small bowel, causing symptoms such as stomach pain, bloating, nausea and weight loss. In most cases DIOS can be controlled with medication.
Gastro oesophageal reflux diease (GORD) in cystic fibrosis
Gastro oesophageal reflux disease (GORD) occurs when acid and non-acid contents of the stomach move in the wrong direction and go back into the oesophagus (gullet). This can cause burning of the oesophagus or ‘heart burn’ and is thought to provoke coughing and possibly contribute to lung damage.
GORD is more common in CF because of excessive coughing, obstructive lung disease, delayed emptying of the stomach, high-fat diet, a lax valve at the bottom of the oesophagus and other CF-specific complications.
Medicines that reduce or neutralise acid in the stomach, or surgery to strengthen the sphincter or valve at the bottom of the oesophagus, may be advised to help treat GORD. It is very common to have treatment to reduce GORD before a lung transplant as reflux and aspiration may increase the risk of lung rejection post-transplant.
Researching digestive issues
We are funding two Strategic Research Centres which are investigating the ways that the digestive system is affected by cystic fibrosis.
- Professor Soraya Shirazi-Beechey's research at the University of Liverpool will investigate ways to prevent blockages in the gut in people with CF by increasing the levels of fluid in the gut to help move digested food along more easily.
- Professor Daniel Peckham's research at the University of Leeds is looking for the link between the balance of bacteria in the gut of a person with cystic fibrosis and the degree of lung inflammation they experience during an infection.