1
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Miles C, Ling N, Paul E, Armstrong D. Presentation, characteristics and management of obstructive intestinal conditions in cystic fibrosis. Frontline Gastroenterol 2024; 15:222-227. [PMID: 38665789 PMCID: PMC11042455 DOI: 10.1136/flgastro-2023-102533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/21/2023] [Indexed: 04/28/2024] Open
Abstract
Objective Constipation and distal intestinal obstruction syndrome (DIOS) are common gastrointestinal manifestations of cystic fibrosis (CF). The primary aim was to describe the characteristics of constipation and DIOS hospitalisations in a paediatric and adult CF service over a 12-year period. The secondary aims were to determine the proportion of constipation and DIOS presentations which met the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) CF Working Group definitions and to describe management strategies of both conditions. Method A retrospective study of children and adults with CF who were admitted with a primary diagnosis of constipation or DIOS between 1 January 2011 and 31 December 2022. ESPGHAN definitions for constipation and DIOS were retrospectively applied to all admissions to determine if the primary medical diagnosis met ESPGHAN criteria. Results During the 12-year study period, 42 hospitalisations for constipation were recorded in 19 patients, and 33 hospitalisations for DIOS were recorded in 23 patients. 88.10% of constipation episodes met ESPGHAN definitions, compared with 3.0% of DIOS episodes. Constipation and DIOS were primarily treated with polyethylene glycol (PEG). The use of sodium amidotrizoate meglumine enemas was significantly higher in the DIOS group (p=0.045). Those admitted with DIOS were significantly less likely to be recommended a weaning dose of PEG (p=0.018). Conclusion Children and adults with CF are more commonly admitted for the management of constipation than DIOS. There is considerable variation in diagnostic and therapeutic practice, and this study highlights the need to enhance the translation and adoption of existing best-practice guidelines.
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Affiliation(s)
- Caitlin Miles
- Nutrition and Dietetics, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Natalie Ling
- Department of Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Eldho Paul
- Monash Centre for Health Research and Implementation (MCHRI), Monash University, Melbourne, Victoria, Australia
| | - David Armstrong
- Department of Respiratory and Sleep Medicine, Monash Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
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2
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Hoppe JE, Sjoberg J, Hong G, Poch K, Zemanick ET, Thee S, Edmondson C, Patel D, Sathe M, Borowitz D, Putman MS, Lechtzin N, Riekert KA, Basile M, Goss CH, Jarosz ME, Rosenfeld M. Remote endpoints for clinical trials in cystic fibrosis: Report from the U.S. CF foundation remote endpoints task force. J Cyst Fibros 2024:S1569-1993(24)00023-7. [PMID: 38429150 DOI: 10.1016/j.jcf.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/18/2024] [Accepted: 02/19/2024] [Indexed: 03/03/2024]
Abstract
The COVID-19 pandemic necessitated a rapid shift in clinical research to perform virtual visits and remote endpoint assessments, providing a key opportunity to optimize the use of remote endpoints for clinical trials in cystic fibrosis. The use of remote endpoints could allow more diverse participation in clinical trials while minimizing participant burden but must be robustly evaluated to ensure adequate performance and feasibility. In response, the Cystic Fibrosis Foundation convened the Remote Endpoint Task Force (Supplemental Table 1), a multidisciplinary group of CF researchers with remote endpoint expertise and community members tasked to better understand the current and future use of remote endpoints for clinical research. Here, we describe the current use of remote endpoints in CF clinical research, address key unanswered questions regarding their use and feasibility, and discuss the next steps to determine clinical trial readiness.
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Affiliation(s)
- Jordana E Hoppe
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora CO, USA.
| | | | - Gina Hong
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia Pennsylvania, USA
| | - Katie Poch
- Department of Medicine, National Jewish Health, Denver CO, USA
| | - Edith T Zemanick
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora CO, USA
| | - Stephanie Thee
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claire Edmondson
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital, London WC1N3JH, USA
| | - Dhiren Patel
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis MO, USA
| | - Meghana Sathe
- Pediatric Gastroenterology and Nutrition, University of Texas Southwestern/Children's Health, Dallas Texas, USA
| | - Drucy Borowitz
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA
| | - Melissa S Putman
- Division of Pediatric Endocrinology, Boston Children's Hospital, Boston MA, USA
| | - Noah Lechtzin
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore Maryland, USA
| | - Kristin A Riekert
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore Maryland, USA
| | - Melissa Basile
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY, USA
| | - Christopher H Goss
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington Medical Center, Seattle Washington, USA; Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Research Institute, Seattle Washington, USA
| | | | - Margaret Rosenfeld
- Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Research Institute, Seattle Washington, USA
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3
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Davis TA, Miller A, Hachem C, Velez C, Patel D. The current state of gastrointestinal motility evaluation in cystic fibrosis: a comprehensive literature review. Transl Gastroenterol Hepatol 2023; 9:10. [PMID: 38317748 PMCID: PMC10838618 DOI: 10.21037/tgh-23-59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/11/2023] [Indexed: 02/07/2024] Open
Abstract
Background and Objective As life expectancy in cystic fibrosis (CF) has increased over the years, a shift in focus toward extra-pulmonary comorbidities such as gastrointestinal (GI) disease has become a topic of particular importance. Although not well-defined in the current literature, GI dysmotility is thought to significantly contribute to GI symptomatology in the CF population. The objective of this article was to provide a comprehensive review of diagnostic modalities at the disposal of the clinician in the evaluation of patients with CF (pwCF) presenting with GI complaints. Furthermore, we aimed to highlight the available literature regarding utilization of these modalities in CF, in addition to their shortcomings, and emphasize areas within the motility literature where further research is essential. Methods A comprehensive review of all available literature in the English language through December 1, 2022 utilizing PubMed was conducted. Our search was limited to GI motility/transit and dysmotility in pwCF. Two researchers independently screened references for applicable articles and extracted pertinent data. Key Content and Findings Several diagnostic imaging and manometry options exist in the evaluation of dysmotility; however, the literature is lacking in high-quality, prospective studies to validate such testing in pwCF. Common symptoms experienced and diagnostic motility tools available based on segment of the GI tract as related to pwCF are explored in the current review. Shortcomings in the current literature are identified and future direction to enhance research efforts within the field of CF-related dysmotility is provided. Conclusions The influence of CF on GI integrity and motility is far-reaching. Despite improvements in longevity and advancement of pulmonary-specific treatment strategies, further high-quality research targeting the evaluation and management of GI dysmotility in pwCF is needed.
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Affiliation(s)
- Trevor A. Davis
- Division of Gastroenterology, Department of Pediatrics, Washington University School of Medicine, Saint Louis Children’s Hospital, St. Louis, MO, USA
| | - Abra Miller
- Division of Gastroenterology, Department of Pediatrics, Saint Louis University School of Medicine, SSM Cardinal Glennon Children’s Medical Center, St. Louis, MO, USA
| | - Christine Hachem
- Division of Gastroenterology, Department of Medicine, Saint Louis University School of Medicine, University Hospital, St. Louis, MO, USA
| | - Christopher Velez
- Division of Gastroenterology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Dhiren Patel
- Division of Gastroenterology, Department of Pediatrics, Saint Louis University School of Medicine, SSM Cardinal Glennon Children’s Medical Center, St. Louis, MO, USA
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4
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Moshiree B, Freeman AJ, Vu PT, Khan U, Ufret-Vincenty C, Heltshe SL, Goss CH, Schwarzenberg SJ, Freedman SD, Borowitz D, Sathe M. Multicenter prospective study showing a high gastrointestinal symptom burden in cystic fibrosis. J Cyst Fibros 2023; 22:266-274. [PMID: 36319569 PMCID: PMC10147845 DOI: 10.1016/j.jcf.2022.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 10/15/2022] [Accepted: 10/16/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND AIMS People with cystic fibrosis (PwCF) suffer from gastrointestinal (GI) symptoms affecting their quality of life (QOL). Despite the relevance of GI symptoms to the overall health of PwCF, a paucity of studies only have comprehensively assessed the prevalence, severity and QOL of GI symptoms in both children and adults with Cystic Fibrosis (CF). METHODS Eligible participants ≥2 years of age across 26 US CF centers were followed for 4 weeks. Three validated GI electronic patient-reported outcome measures (ePROMs) with a recall period of 2 weeks and a stool-specific questionnaire were administered weekly over four weeks. Total and domain scores of ePROMs were evaluated overall and in subgroups using linear mixed-effect models. RESULTS Of 402 enrolled, 58% were ≥ 18 years of age (52% male). The mean (SD) of the total score for PAC-SYM was 0.52 (0.55), for PAGI-SYM was 0.63 (0.67), and for PAC-QOL was 0.67 (0.55). For specific ePROM questions, prevalence of moderate to very severe symptoms were as follows: straining (20.3%), fullness (18.3%), incomplete bowel movements (17.1%), bloating (16.4%), distension (16.4%), abdominal pain (upper-5.1%, lower-7.5%). Comparing participants ≥18 versus <18, a higher prevalence of bloating (63.7% versus 27.3%), lower abdominal pain (39.8% vs 26.2%), stomach fullness (75.6% versus 56.2%), and abdominal distension (60.2% versus 34.9%) was found. Both age groups reported high treatment dissatisfaction as measured with PAC-QOL, mean 1.39 (95% CI: 1.30, 1.47). CONCLUSION GI symptoms were reported in all age ranges irrespective of gender, with higher prevalence observed amongst older and female subgroups. Dissatisfaction with GI targeted treatments were reported in a large proportion of participants despite therapy, highlighting an unmet need for clinical interventions. CLINICALTRIALS GOV: NCT03801993.
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Affiliation(s)
- Baha Moshiree
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Atrium Health, Charlotte, NC, United States.
| | - A Jay Freeman
- Division of Pediatric Gastroenterology, Nationwide Children's Hospital/The Ohio State University, Columbus, OH, United States
| | - Phuong T Vu
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle WA, United States
| | - Umer Khan
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle WA, United States
| | - Carmen Ufret-Vincenty
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle WA, United States
| | - Sonya L Heltshe
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle WA, United States; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Christopher H Goss
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle WA, United States; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States; Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Sarah Jane Schwarzenberg
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States
| | - Steven D Freedman
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Drucy Borowitz
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - Meghana Sathe
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Texas Southwestern/Children's Health, Dallas, TX, United States
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5
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Britto CJ, Ratjen F, Clancy JP. Emerging Approaches to Monitor and Modify Care in the Era of Cystic Fibrosis Transmembrane Conductance Regulators. Clin Chest Med 2022; 43:631-646. [PMID: 36344071 DOI: 10.1016/j.ccm.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
As we characterize the clinical benefits of highly effective modulator therapy (HEMT) in the cystic fibrosis (CF) population, our paradigm for treating and monitoring disease continues to evolve. More sensitive approaches are necessary to detect early disease and clinical progression. This article reviews evolving strategies to assess disease control and progression in the HEMT era. This article also explores developments in pulmonary function monitoring, advanced respiratory imaging, tools for the collection of patient-reported outcomes, and their application to profile individual responses, guide therapeutic decisions, and improve the quality of life of people with CF.
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Affiliation(s)
- Clemente J Britto
- Yale Adult Cystic Fibrosis Program, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine.
| | - Felix Ratjen
- Division of Respiratory Medicine, Translational Medicine, University of Toronto Hospital for Sick Children, 555 University Avenue, Toronto Ontario M5G 1X8, Canada
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6
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Britto CJ, Taylor-Cousar JL. Cystic Fibrosis in the Era of Highly Effective CFTR Modulators. Clin Chest Med 2022; 43:xiii-xvi. [PMID: 36344084 DOI: 10.1016/j.ccm.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Clemente J Britto
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, 300 Cedar Street, TAC-S419, New Haven, CT 06520, USA.
| | - Jennifer L Taylor-Cousar
- Departments of Medicine and Pediatrics, Divisions of Pulmonary Sciences and Critical Care Medicine and Pediatric Pulmonology, University of Colorado, Anschutz Medical Campus, 1400 Jackson Street, J318, Denver, CO 80206, USA.
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7
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Anderson JL, Tierney AC, Miles C, Kotsimbos T, King SJ. Probiotic knowledge of adults with cystic fibrosis is limited but is associated with probiotic use: A cross-sectional survey study. Nutr Health 2022:2601060221136653. [PMID: 36366805 DOI: 10.1177/02601060221136653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background: Probiotics are used by people with cystic fibrosis (CF) and other chronic diseases to manage gastrointestinal symptoms. Aim: To describe probiotic knowledge; its relationship with probiotic use, probiotic information sources and factors influencing choice in adults with CF and a general population control group. Methods: A cross-sectional questionnaire study was conducted in adults with CF (n = 205) and Controls (n = 158). Probiotic knowledge was compared between CF and Controls using a knowledge score (maximum 5) based on predefined criteria: (1a) bacteria/microorganism; (1b) live; (2a) administered; (2b) adequate dose and (3) health benefit, using independent samples t-test. Two-way analysis of variance explored knowledge scores between CF and Control and between Ever User and Never User groups. Chi-square and Fisher's exact tests compared knowledge criterion, probiotic sources and influences on probiotic choice between groups. Thematic analysis of open-text responses explored probiotic-related knowledge and influences on probiotic decision making. Results: Knowledge scores (mean ± SD) did not differ between CF (1.70 ± 1.12) and Controls (1.89 ± 0.99), p = 0.13. Probiotic use was associated with knowledge score (p < 0.001). More CF Ever Users than Never Users correctly identified criteria 1a (65% vs. 38%), 1b (16% vs. 0%), 2a (45% vs. 22%) and 3 (73% vs. 42%) (all p < 0.005). CF participants considered 'dairy yoghurt' (69%), 'live cultures' (64%) and 'fermented foods' (37%) as 'all/mostly' probiotic sources. The internet was the commonest source of probiotic-related information. Conclusion: Probiotic knowledge and use were associated in adults with CF. Understanding of probiotic characteristics and sources were limited. Education is needed to help guide patient probiotic decision making.
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Affiliation(s)
- Jacqueline L Anderson
- Discipline of Food, Nutrition and Dietetics, School of Allied Health, 2080La Trobe University, Bundoora, Australia
| | - Audrey C Tierney
- Discipline of Food, Nutrition and Dietetics, School of Allied Health, 2080La Trobe University, Bundoora, Australia
- School of Allied Health, Health Implementation Science and Technology Centre, Health Research Institute, 8808University of Limerick, Limerick, Ireland
| | - Caitlin Miles
- Nutrition and Dietetics Department, 2538Monash Health, Clayton, Australia
| | - Tom Kotsimbos
- Cystic Fibrosis Service, Department of Allergy, Immunology and Respiratory Medicine, 5392Alfred Health, Melbourne, Australia
- Department of Medicine, 2541Monash University, Melbourne, Australia
| | - Susannah J King
- Discipline of Food, Nutrition and Dietetics, School of Allied Health, 2080La Trobe University, Bundoora, Australia
- Nutrition Department, 5392Alfred Health, Melbourne, Australia
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8
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Borowitz D, Brooks JF, Aliaj E, Gallotto D. Community Perspective on Pancreatic Enzyme Replacement Therapy in Cystic Fibrosis. J Pediatr Gastroenterol Nutr 2022; 75:e94-e97. [PMID: 36070542 DOI: 10.1097/mpg.0000000000003606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
People with cystic fibrosis (CF) and exocrine pancreatic insufficiency must take pancreatic enzyme replacement therapy (PERT) to prevent malnutrition and gastrointestinal (GI) symptoms. Finding better ways to manage GI complaints is a high priority for the CF community. We fielded a survey to assess the perspective of people affected by CF regarding symptoms attributed to and challenges associated with current PERT, to identify factors that affect participation in PERT studies, and to understand attitudes toward an outcome measure that could be an alternative to the coefficient of fat absorption test. Persistent GI symptoms are commonly ascribed to PERT. Minimizing time commitment and maximizing patient safety were factors affecting participation in research. We demonstrate 4 generalizable ways to incorporate patient experience early in the research process to aid in development of new medications and help improve study enrollment.
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Affiliation(s)
- Drucy Borowitz
- From the University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | | | - Enid Aliaj
- the Cystic Fibrosis Foundation, Bethesda, MD
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9
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Freeman AJ, Huang R, Heltshe SL, Gelfond D, Leung DH, Ramsey BR, Borowitz D, Sathe M. Association between stool consistency and clinical variables among infants with cystic fibrosis: Findings from the BONUS study. J Cyst Fibros 2022; 21:830-836. [PMID: 35585010 PMCID: PMC10056424 DOI: 10.1016/j.jcf.2022.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/04/2022] [Accepted: 05/06/2022] [Indexed: 12/09/2022]
Abstract
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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Affiliation(s)
- A Jay Freeman
- Associate Professor, Division Gastroenterology, Hepatology and Nutrition, Children's Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, GA, USA.
| | - Rong Huang
- Lead Biostatistician, Research Administration, Children's Medical Center Dallas, Dallas, TX, USA
| | - Sonya L Heltshe
- Associate Professor, Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle, WA, USA and Division of Pulmonary Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Daniel Gelfond
- WNY Pediatric Gastroenterology and Volunteer Faculty, University of Buffalo School of Medicine, Buffalo, NY, USA
| | - Daniel H Leung
- Associate Professor, Division of Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Bonnie R Ramsey
- Vice Chair and Endowed Professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Drucy Borowitz
- Emeritus Clinical Professor of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Meghana Sathe
- Associate Professor, Division Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Texas Southwestern and Children's Health, Dallas, TX, USA
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10
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Barr HL, Bihouee T, Zwitserloot AM. A year in review: Real world evidence, functional monitoring and emerging therapeutics in 2021. J Cyst Fibros 2022; 21:191-196. [PMID: 35272931 PMCID: PMC8900606 DOI: 10.1016/j.jcf.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/23/2022] [Indexed: 12/20/2022]
Affiliation(s)
- H L Barr
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Nottingham Respiratory Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom.
| | - T Bihouee
- Chronic Childhood Diseases unit, Pediatric Department, Nantes University Hospital, Nantes, France
| | - A M Zwitserloot
- University of Groningen, Department of Pediatric Pulmonology and Pediatric Allergy, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
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11
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Lahiri T, Sullivan JS. Recent advances in the early treatment of cystic fibrosis: Bridging the gap to highly effective modulator therapy. Pediatr Pulmonol 2022; 57 Suppl 1:S60-S74. [PMID: 34473419 DOI: 10.1002/ppul.25660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/22/2021] [Accepted: 09/01/2021] [Indexed: 11/08/2022]
Abstract
Highly effective modulator therapy (HEMT) for cystic fibrosis (CF) has been touted as one of the greatest advances to date in CF care. As these therapies are now available for many older children and adults with CF, marked improvement of their nutritional status, pulmonary and gastrointestinal symptoms has been observed. However, most infants and younger children are not current candidates for HEMT due to age and/or cystic fibrosis transmembrane conductance regulator (CFTR) mutation. For these young children, it is essential to provide rigorous monitoring and care to avoid potential disease sequelae while awaiting HEMT availability. The following article highlights recent advances in the care of infants and young children with CF with regard to surveillance and treatment of nutritional, pulmonary, and gastrointestinal disorders. Recent clinical trials in this population are also reviewed.
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Affiliation(s)
- Thomas Lahiri
- Divisions of Pediatric Pulmonology and Gastroenterology, University of Vermont Children's Hospital, Burlington, Vermont, USA
| | - Jillian S Sullivan
- Divisions of Pediatric Pulmonology and Gastroenterology, University of Vermont Children's Hospital, Burlington, Vermont, USA
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12
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Anderson JL, Tierney AC, Miles C, Kotsimbos T, King SJ. PROBIOTIC USE IN ADULTS WITH CYSTIC FIBROSIS IS COMMON AND INFLUENCED BY GASTROINTESTINAL HEALTH NEEDS: A CROSS SECTIONAL SURVEY STUDY. J Hum Nutr Diet 2022; 35:444-454. [DOI: 10.1111/jhn.12991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/10/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Jacqueline L Anderson
- Department of Dietetics, Nutrition and Sport, School of Allied Health La Trobe University Victoria Australia
| | - Audrey C Tierney
- Department of Dietetics, Nutrition and Sport, School of Allied Health La Trobe University Victoria Australia
- School of Allied Health, Health Implementation Science and Technology Centre, Health Research Institute University of Limerick Limerick Ireland
| | - Caitlin Miles
- Nutrition and Dietetics Department, Monash Health Clayton Victoria Australia
| | - Tom Kotsimbos
- Cystic Fibrosis Service, Department of Allergy, Immunology and Respiratory Medicine, Alfred Health Melbourne Victoria Australia
- Department of Medicine Monash University Melbourne Australia
| | - Susannah J King
- Department of Dietetics, Nutrition and Sport, School of Allied Health La Trobe University Victoria Australia
- Cystic Fibrosis Service, Department of Allergy, Immunology and Respiratory Medicine, Alfred Health Melbourne Victoria Australia
- Nutrition Department Alfred Health Melbourne Victoria Australia
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13
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Birimberg-Schwartz L, Wilschanski M. Cystic Fibrosis Related Gastrointestinal Manifestations - Moving Forward. J Cyst Fibros 2021; 20:562-563. [PMID: 34452731 DOI: 10.1016/j.jcf.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Liron Birimberg-Schwartz
- Department of Pediatric Gastroenterology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Michael Wilschanski
- Department of Pediatric Gastroenterology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
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14
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The Intestinal Microbiome and Cystic Fibrosis Transmembrane Conductance Regulator Modulators: Emerging Themes in the Management of Gastrointestinal Manifestations of Cystic Fibrosis. Curr Gastroenterol Rep 2021; 23:17. [PMID: 34448955 DOI: 10.1007/s11894-021-00817-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW While commonly associated with pulmonary manifestations, cystic fibrosis (CF) is a systemic disease with wide-ranging effects on the gastrointestinal (GI) tract. This article reviews major recent updates in gastroenterological CF care and research. RECENT FINDINGS The high burden of GI symptoms in CF has led to recent studies assessing GI-specific symptom questionnaires and scoring systems. Intestinal dysbiosis potentially contributes to gastrointestinal symptoms in patients with CF and an increased risk of gastrointestinal cancers in CF. An increased incidence of colorectal cancer (CRC) has led to CF-specific CRC screening and surveillance recommendations. Pharmacologic therapies targeting specific cystic fibrosis transmembrane conductance regulator (CFTR) mutations have shown promise in treating GI manifestations of CF. New research has highlighted the importance of intestinal dysbiosis in CF. Future studies should assess whether CFTR modulators affect the gut microbiome and whether altering the gut microbiome will impact GI symptoms and GI cancer risk.
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Sathe M, Moshiree B, Vu PT, Khan U, Heltshe SL, Romasco M, Freedman SD, Schwarzenberg SJ, Goss CH, Freeman AJ. Utilization of electronic patient-reported outcome measures in cystic fibrosis research: Application to the GALAXY study. J Cyst Fibros 2021; 20:605-611. [PMID: 34305007 DOI: 10.1016/j.jcf.2021.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/30/2021] [Accepted: 07/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Food and Drug Administration considers patient-reported outcome measures (PROMs) an essential part of clinical research studies for approval of new drugs and new indications for existing drugs. GALAXY evaluated the feasibility of electronic PROMs (ePROMS) to conduct a comprehensive evaluation of gastrointestinal (GI) symptoms in persons with cystic fibrosis (pwCF). METHODS Three validated GI ePROMs (PAC-SYM, PAGI-SYM and PAC-QOL) were combined with a Stool-Specific questionnaire to make up the GALAXY ePROMs and administered prospectively across 26 CF centers in the United States. The ePROMs were completed at enrollment visit and then electronically at weeks 1, 2 and 4. PwCF at least 2 years and older were eligible for the study. Reminders were only provided by the mobile application during the study window. RESULTS There were 402 participants enrolled in GALAXY. Of those, 169 (42%) were under 18 years old and 193 (48%) were female. The proportion of all follow-up weeks with at least 1 ePROM fully completed was 80%, slightly higher in those ≥18 years of age (82.5%) compared to those <18 years of age (76.5%). When assessing the completion for all 4 ePROMs, the percentage was 77.6%, also higher among those ≥18 year of age (81.5% versus 72.2% for < 18 years of age). CONCLUSION Using ePROMs, our study demonstrated that GI symptoms can be feasibly collected with good reproducibility and with minimal involvement of research coordinator time. This mechanism of symptom collection may provide an efficient tool for future CF trials.
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Affiliation(s)
- Meghana Sathe
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Texas Southwestern/Children's Health, Dallas, TX.
| | - Baha Moshiree
- Division of Gastroenterology, Atrium Health, Charlotte, NC
| | - Phuong T Vu
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle WA
| | - Umer Khan
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle WA
| | - Sonya L Heltshe
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle WA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Melita Romasco
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle WA
| | - Steven D Freedman
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Christopher H Goss
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle WA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA; Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - A Jay Freeman
- Division of Gastroenterology, Hepatology and Nutrition, Children's Healthcare of Atlanta, Emory University, Atlanta, GA
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