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Infantes FNS, Lomazi EA, Zagoya C, Duckstein F, Magro DO, Pessotto F, Ribeiro AF, Ribeiro JD, Mainz JG. Cross-cultural adaptation and validation of the CFAbd-Score for gastrointestinal symptoms in patients with cystic fibrosis. J Pediatr (Rio J) 2024:S0021-7557(24)00092-5. [PMID: 39134095 DOI: 10.1016/j.jped.2024.07.004] [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: 03/11/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 08/27/2024] Open
Abstract
OBJECTIVE Translating and cross-culturally adapting the CFAbd-Score, Cystic Fibrosis (CF) Abdominal Score, to use in Brazilian spoken Portuguese. The CFAbd-Score is a questionnaire for assessing CF-related abdominal symptoms and their influence on the quality of life (QoL). It comprises 28 questions on five domains: abdominal pain, bowel movements, eating and appetite, gastroesophageal reflux symptoms, and the impact of gastrointestinal (GI) symptoms on QoL. METHOD Cross-cultural adaptation included assessment of conceptual and item equivalence, semantic, operational, and measurement equivalence. Content validity was assessed. The validation and psychometric analysis phase included 97 people with CF (pwCF), median age:14.58y (IQR 9/19), and 105 healthy individuals, 15.10y (IQR 9/20). Exploratory factor analysis (FA) identified retained factors. Internal consistency of the extracted domains was evaluated using Cronbach's α, and the Kaiser-Meyer-Olkin test (KMO) was used to check the sample adequacy. Bartlett's test tested the null hypothesis that the correlation matrix is an identity matrix. RESULTS All items were considered relevant to the construct and good semantic equivalence of the version was recognized. FA showed the appropriate weight of all items and good internal consistency, with Cronbach's alpha 0.89. Bartlett's test significance level (p < 0.001) and KMO coefficient of 0.72 indicated good adequacy for structure. Internal consistency coefficients (Cronbach's alpha) were good for abdominal pain: 0.84; abdominal bloating: 0.73; flatulence: 0.76; heartburn: 0.81, and low for reflux: 0.54. CONCLUSION The CFAbd-Score was adapted to the Brazilian spoken Portuguese and demonstrated content and semantic equivalence. The final version showed appropriate validity, and internal consistency, preserving the psychometric properties of the original version.
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Affiliation(s)
- Flávia N S Infantes
- Universidade Estadual de Campinas (UNICAMP), Pós-Graduação em Saúde da Criança e do Adolescente, Campinas, SP, Brazil; Centro Universitário UniAnchieta, Faculdade de Nutrição, Jundiaí, SP, Brazil
| | - Elizete A Lomazi
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas (FCM), Departamento de Pediatria, Campinas, SP, Brazil.
| | - Carlos Zagoya
- University, Klinikum Westbrandenburg, Cystic Fibrosis Centre, Brandenburg Medical School (MHB), Brandenburg an der Havel, Germany
| | - Franziska Duckstein
- University, Klinikum Westbrandenburg, Cystic Fibrosis Centre, Brandenburg Medical School (MHB), Brandenburg an der Havel, Germany
| | - Daniela O Magro
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas (FCM), Departamento de Cirurgia, Campinas, SP, Brazil
| | - Fernando Pessotto
- Centro Universitário UniAnchieta, Faculdade de Psicologia, Jundiaí, SP, Brazil
| | - Antônio F Ribeiro
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas (FCM), Departamento de Pediatria, Campinas, SP, Brazil
| | - José D Ribeiro
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas (FCM), Departamento de Pediatria, Campinas, SP, Brazil
| | - Jochen G Mainz
- University, Klinikum Westbrandenburg, Cystic Fibrosis Centre, Brandenburg Medical School (MHB), Brandenburg an der Havel, Germany
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Alexander A, Helmick R, Plumb T, Alshaikh E, Jadcherla SR. Characterizing Biomarkers of Continuous Peristalsis and Bolus Transit During Oral Feeding in Infants at pH-Impedance Evaluation: Clinical and Research Implications. J Pediatr 2024; 274:114154. [PMID: 38897379 DOI: 10.1016/j.jpeds.2024.114154] [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: 02/15/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To examine the biomarkers of pharyngoesophageal swallowing during oral feeding sessions in infants undergoing pH-impedance testing and determine whether swallow frequencies are distinct between oral-fed and partially oral-fed infants. STUDY DESIGN One oral feeding session was performed in 40 infants during pH-impedance studies and measurements included swallowing frequency, multiple swallow rate, air and liquid swallow rates, esophageal swallow clearance time, and gastroesophageal reflux (GER) characteristics. Linear and mixed statistical models were applied to examine the swallowing markers and outcomes. RESULTS Infants (30.2 ± 4.4 weeks' birth gestation) were evaluated at 41.2 ± 0.4 weeks' postmenstrual age. Overall, 10 675 swallows were analyzed during the oral feeding sessions (19.3 ± 5.4 minutes per infant) and GER events were noted (2.5 ± 0.3 per study). Twenty-four-hour acid reflux index (ARI) was 9.5 ± 2.0%. Differences were noted in oral-fed and partially oral-fed infants for volume consumption (P < .01), consumption rate (P < .01), and length of hospital stay in days (P < .01). Infants with ARI >7% had greater frequency of swallows (P = .01). The oral-fed group had greater ARI (12.7 ± 3.3%, P = .05). CONCLUSIONS Oropharyngeal swallowing regulatory characteristics decrease over the feeding duration and were different between ARI >7% vs ≤7%. Although GER is less in infants who are partially oral-fed, the neonates with increased acid exposure achieved greater oral intakes and shorter hospitalizations, despite the presence of comorbidities. Pharyngoesophageal stimulation as during consistent feeding or GER events can activate peristaltic responses and rhythms, which may be contributory to the findings.
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Affiliation(s)
- Alexis Alexander
- The Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, Columbus, OH; Center for Perinatal Research, The Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Roseanna Helmick
- The Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, Columbus, OH; Center for Perinatal Research, The Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Toni Plumb
- The Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, Columbus, OH; Center for Perinatal Research, The Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Enas Alshaikh
- The Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, Columbus, OH; Center for Perinatal Research, The Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Sudarshan R Jadcherla
- The Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, Columbus, OH; Center for Perinatal Research, The Research Institute, Nationwide Children's Hospital, Columbus, OH; Division of Neonatology, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.
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McDonald CM, Reid EK, Pohl JF, Yuzyuk TK, Padula LM, Vavrina K, Altman K. Cystic fibrosis and fat malabsorption: Pathophysiology of the cystic fibrosis gastrointestinal tract and the impact of highly effective CFTR modulator therapy. Nutr Clin Pract 2024; 39 Suppl 1:S57-S77. [PMID: 38429959 DOI: 10.1002/ncp.11122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/28/2023] [Accepted: 12/28/2023] [Indexed: 03/03/2024] Open
Abstract
Cystic fibrosis (CF) is a progressive, genetic, multi-organ disease affecting the respiratory, digestive, endocrine, and reproductive systems. CF can affect any aspect of the gastrointestinal (GI) tract, including the esophagus, stomach, small intestine, colon, pancreas, liver, and gall bladder. GI pathophysiology associated with CF results from CF membrane conductance regulator (CFTR) dysfunction. The majority of people with CF (pwCF) experience exocrine pancreatic insufficiency resulting in malabsorption of nutrients and malnutrition. Additionally, other factors can cause or worsen fat malabsorption, including the potential for short gut syndrome with a history of meconium ileus, hepatobiliary diseases, and disrupted intraluminal factors, such as inadequate bile salts, abnormal pH, intestinal microbiome changes, and small intestinal bacterial overgrowth. Signs and symptoms associated with fat malabsorption, such as abdominal pain, bloating, malodorous flatus, gastroesophageal reflux, nausea, anorexia, steatorrhea, constipation, and distal intestinal obstruction syndrome, are seen in pwCF despite the use of pancreatic enzyme replacement therapy. Given the association of poor nutrition status with lung function decline and increased mortality, aggressive nutrition support is essential in CF care to optimize growth in children and to achieve and maintain a healthy body mass index in adults. The introduction of highly effective CFTR modulator therapy and other advances in CF care have profoundly changed the course of CF management. However, GI symptoms in some pwCF may persist. The use of current knowledge of the pathophysiology of the CF GI tract as well as appropriate, individualized management of GI symptoms continue to be integral components of care for pwCF.
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Affiliation(s)
| | - Elizabeth K Reid
- Cystic Fibrosis Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - John F Pohl
- Pediatric Gastroenterology, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Tatiana K Yuzyuk
- Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- ARUP Institute for Clinical & Experimental Pathology, Salt Lake City, Utah, USA
| | - Laura M Padula
- Pediatric Specialty, University Health, San Antonio, Texas, USA
| | - Kay Vavrina
- Pediatric Specialty, University Health, San Antonio, Texas, USA
| | - Kimberly Altman
- Gunnar Esiason Adult Cystic Fibrosis and Lung Center, Columbia University Medical Center, New York, New York, USA
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Patel D, Jose F, Baker J, Moshiree B. Neurogastroenterology and Motility Disorders of the Gastrointestinal Tract in Cystic Fibrosis. Curr Gastroenterol Rep 2024; 26:9-19. [PMID: 38057499 DOI: 10.1007/s11894-023-00906-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE OF REVIEW To discuss all the various motility disorders impacting people with Cystic Fibrosis (PwCF) and provide diagnostic and management approaches from a group of pediatric and adult CF and motility experts and physiologists with experience in the management of this disease. RECENT FINDINGS Gastrointestinal (GI) symptoms coexist with pulmonary symptoms in PwCF regardless of age and sex. The GI manifestations include gastroesophageal reflux disease, esophageal dysmotility gastroparesis, small bowel dysmotility, small intestinal bacterial overgrowth syndrome, distal idiopathic obstruction syndrome, constipation, and pelvic floor disorders. They are quite debilitating, limiting the patients' quality of life and affecting their nutrition and ability to socialize. This genetic disorder affects many organ systems and is chronic, potentially impacting fertility and future family planning, requiring a multidisciplinary approach. Our review discusses the treatments of motility disorders in CF, their prevalence and pathophysiology. We have provided a framework for clinicians who care for these patients that can help to guide their clinical management.
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Affiliation(s)
- Dhiren Patel
- Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, SSM Cardinal Glennon Children's Medical Center, Saint Louis University, St Louis, MO, USA
| | - Folashade Jose
- Pediatric Gastroenterology, Hepatology, and Nutrition, Clinical Associate Professor, Levine Childrens Hospital, Carolina Pediatric Gastroenterology, Charlotte, NC, USA
| | | | - Baha Moshiree
- Division of Gastroenterology, Atrium Health Wake Forest Medical University, Charlotte, NC, USA.
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Yule A, Sills D, Smith S, Spiller R, Smyth AR. Thinking outside the box: a review of gastrointestinal symptoms and complications in cystic fibrosis. Expert Rev Respir Med 2023; 17:547-561. [PMID: 37345513 DOI: 10.1080/17476348.2023.2228194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/19/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Gastrointestinal (GI)-related symptoms, complications, and comorbidities in cystic fibrosis (CF) are common and research to reduce their burden is a priority for the CF community. To enable future research, this review aimed to summarize the range of GI symptoms, complications and comorbidities seen in CF, the underlying pathophysiology, and treatments. AREAS COVERED This was a rapid systematic review undertaken using the recommendations from the Cochrane Rapid Reviews Methods Group. We searched databases including PubMed, Embase, Medline and the Cochrane database and identified those studies reporting GI-related symptoms, complications, or comorbidities in CF or their treatment. Our searches identified 2,930 studies and a total 119 studies met our inclusion criteria. Where a prevalence could be determined, GI symptoms were reported in 33.7% of study participants. The range of symptoms reported was broad and the highest median prevalence included flatulence (43.5%), bloating and abdominal distension (36%), and fatty stool (36%). Meconium ileus was reported in 12% and distal intestinal obstruction syndrome in 8.5. EXPERT OPINION GI-related symptoms, complications, and comorbidities in CF are common. More consistent characterization and recording of these symptoms in clinical studies may help achieve the priority of reducing the burden of GI disease in CF.
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Affiliation(s)
- Alexander Yule
- Academic Unit of Lifespan & Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Biomedical Research Centre, Nottingham University Hospital NHS Trust and University of Nottingham, Nottingham, UK
| | - Darren Sills
- Nutrition and Dietetics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sherie Smith
- Academic Unit of Lifespan & Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Robin Spiller
- NIHR Biomedical Research Centre, Nottingham University Hospital NHS Trust and University of Nottingham, Nottingham, UK
- Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Alan R Smyth
- Academic Unit of Lifespan & Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Biomedical Research Centre, Nottingham University Hospital NHS Trust and University of Nottingham, Nottingham, UK
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Gonçalves EDS, Ribeiro JD, Marson FAL, Montes CG, Ribeiro AF, Mainz JG, Toro AADC, Zamariola JH, Borgli DSP, Lomazi EA, Servidoni MDFCP. Combined multi-channel intraluminal impedance measurement and pHmetry in the detection of gastroesophageal reflux disease in children with cystic fibrosis. J Pediatr (Rio J) 2022; 99:269-277. [PMID: 36564006 DOI: 10.1016/j.jped.2022.11.007] [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: 07/17/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To assess the prevalence of GERD exclusively by means of multichannel intraluminal impedanciometry associated with pH monitoring (MIIpH) and compare it with respiratory symptoms in children with CF. To compare MIIpH with pHmetry alone to perform GERD diagnosis. METHODS An analytical cross-sectional study was conducted with children diagnosed with CF who underwent MIIpH. Clinical and laboratory markers, including respiratory and digestive symptoms, were used for comparative analyses. High-resolution chest computed tomography was performed on patients with symptoms of chronic lung disease. Severity was classified according to the Bhalla score. RESULTS A total of 29 children < 10 yo (18 girls) were evaluated; 19 of whom with physiological GER and 10 with GERD. Of the children with GERD, seven had predominantly acid GER, two acid+non-acid GER, and one non-acid GER. Three patients had GERD diagnosed only by MIIpH. Bhalla scores ranged from seven to 17.75 with no significant relationship with GERD. The number of pulmonary exacerbations was associated with a decrease in esophageal clearance regardless of the position in pHmetry and MIIpH. CONCLUSIONS The prevalence of GERD was 34% in children with CF. There was no association between respiratory disease severity and GER types. MIIpH detected 30% more patients with GERD than pHmetry.
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Affiliation(s)
- Emília da Silva Gonçalves
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Pediatria, Centro de Pesquisa Pediátrica, Laboratório de Fibrose Cística e Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil.
| | - José Dirceu Ribeiro
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Pediatria, Centro de Pesquisa Pediátrica, Laboratório de Fibrose Cística e Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil.
| | - Fernando Augusto Lima Marson
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Pediatria, Centro de Pesquisa Pediátrica, Laboratório de Fibrose Cística e Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil; Universidade São Francisco, Laboratório de Genética Médica e Medicina Genômica, Pós-Graduação em Ciências da Saúde, Bragança Paulista, SP, Brazil; Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Centro de Diagnóstico de Doenças do Aparelho Digestivo (Gastrocentro), Campinas, SP, Brazil
| | - Ciro Garcia Montes
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Centro de Diagnóstico de Doenças do Aparelho Digestivo (Gastrocentro), Campinas, SP, Brazil
| | - Antônio Fernando Ribeiro
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Pediatria, Centro de Pesquisa Pediátrica, Laboratório de Fibrose Cística e Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil
| | - Jochen Georg Mainz
- University Klinikum Westbrandenburg Klinik für Kinder- und Jugendmedizin, Brandenburg Medical School (MHB), Head of Pediatric Pulmonology and Cystic Fibrosis, Hochstraße, Germany
| | - Adyléia Aparecida Dalbo Contrera Toro
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Pediatria, Centro de Pesquisa Pediátrica, Laboratório de Fibrose Cística e Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil
| | - Juliana Helena Zamariola
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Pediatria, Centro de Pesquisa Pediátrica, Laboratório de Fibrose Cística e Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil
| | - Daniela Souza Paiva Borgli
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Pediatria, Centro de Pesquisa Pediátrica, Laboratório de Fibrose Cística e Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil
| | - Elizete Aparecida Lomazi
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Pediatria, Centro de Pesquisa Pediátrica, Laboratório de Fibrose Cística e Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil
| | - Maria de Fátima Corrêa Pimenta Servidoni
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Pediatria, Centro de Pesquisa Pediátrica, Laboratório de Fibrose Cística e Laboratório de Fisiologia Pulmonar, Campinas, SP, Brazil; Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Centro de Diagnóstico de Doenças do Aparelho Digestivo (Gastrocentro), Campinas, SP, Brazil
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Woodley FW, Williams K, Di Lorenzo C, Michel HK. Significant Temporal Association of Esophageal Air Events (Supragastric Belches, Air Swallows, and Gastric Belches) With Hiccups: A Case Study in an Adolescent. JPGN REPORTS 2022; 3:e209. [PMID: 37168628 PMCID: PMC10158523 DOI: 10.1097/pg9.0000000000000209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 04/11/2022] [Indexed: 05/13/2023]
Abstract
We previously reported our ability to objectively assess the strength of temporal relationships between gastroesophageal reflux (GER) disease-like symptoms with esophageal air events (EAEs) (air swallows, gastric belching, and supragastric belching) using impedance-pH monitoring. Recently, we similarly evaluated an adolescent female who presented to our clinic with symptoms of recurrent hiccups and with what appeared to be numerous EAEs. Hiccups were associated with GER (symptom association probability [SAP] = 100%), air swallows (SAP = 99.7%), supragastric belches (SAP = 100%), and gastric belches (SAP = 100%), with almost twice as many of the supragastric belches preceding a hiccup than any of the other 3 esophageal disturbance types (EDs) (P < 0.00001). Our data showing a significant temporal association between EAEs and hiccups support a previous report in which belching was suspected of being associated with hiccups in an adult male. Reports such as this underscore the importance of considering the assessment of temporal relationships between extra-esophageal symptoms and EDs that include not only GER, but also EAEs, such as air swallows, gastric belches and supragastric belches, when devising strategies for clinical management of patients with hiccups.
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Affiliation(s)
- Frederick W. Woodley
- From the Center for Motility Disorders, Nationwide Children’s Hospital, Columbus, OH
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children’s Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Kent Williams
- From the Center for Motility Disorders, Nationwide Children’s Hospital, Columbus, OH
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children’s Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Carlo Di Lorenzo
- From the Center for Motility Disorders, Nationwide Children’s Hospital, Columbus, OH
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children’s Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Hilary K. Michel
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children’s Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
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Alaber O, Sabe R, Baez-Socorro V, Sankararaman S, Roesch E, Sferra TJ. Epidemiology of Eosinophilic Esophagitis in Patients with Cystic Fibrosis: A Population-Based 5-Year Study. Pediatr Gastroenterol Hepatol Nutr 2022; 25:283-292. [PMID: 35903489 PMCID: PMC9284113 DOI: 10.5223/pghn.2022.25.4.283] [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: 11/06/2021] [Revised: 04/10/2022] [Accepted: 05/19/2022] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The prevalence of eosinophilic esophagitis (EoE) has been on the rise since it was first described in the 1990s. Several diseases and exogenous factors have been associated with EoE. Our aim was to investigate the epidemiology of EoE in cystic fibrosis (CF) patients. METHODS We identified individuals with CF from September 2014 to September 2019 within a database (IBM Explorys Solutions, Inc.). The prevalence of EoE in patients with CF was compared to the general population. RESULTS The database included 36,111,860 patients during the 5-year study period: 12,950 with CF (0.036%) and 28,090 with EoE (0.078%). EoE prevalence was higher in CF patients than the general population (46 in 10,000 vs. 7.8 in 10,000, p<0.001). Patients with CF and EoE were more likely to be male (50% vs. 33.5%, p<0.008), children (33.3% vs. 16.5%, p<0.001), and non-Hispanic (100% vs. 88.7%, p<0.001) than CF patients without EoE. CF with EoE patients were more likely to be children than EoE only (33.3% vs. 10.5%, p<0.001). Allergic conditions were generally more prevalent in CF with EoE than CF only (83.3% vs. 68.3%, p=0.01) and EoE only (83.3% vs. 69.3%, p=0.014). CONCLUSION EoE is nearly 6-times more prevalent in CF patients. Those patients had higher incidence of other atopic conditions. EoE must be considered in the differential diagnosis of patients with CF presenting with dysphagia, refractory gastroesophageal reflux, vomiting, and other esophagus-related symptoms.
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Affiliation(s)
- Omar Alaber
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ramy Sabe
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Pediatrics Gastroenterology, Hepatology and Nutrition, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Virginia Baez-Socorro
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Pediatrics Gastroenterology, Hepatology and Nutrition, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Senthilkumar Sankararaman
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Pediatrics Gastroenterology, Hepatology and Nutrition, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Erica Roesch
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Pediatric Pulmonology, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Thomas J Sferra
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Pediatrics Gastroenterology, Hepatology and Nutrition, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA
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Systems Biology and Bile Acid Signalling in Microbiome-Host Interactions in the Cystic Fibrosis Lung. Antibiotics (Basel) 2021; 10:antibiotics10070766. [PMID: 34202495 PMCID: PMC8300688 DOI: 10.3390/antibiotics10070766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/14/2021] [Accepted: 06/21/2021] [Indexed: 12/16/2022] Open
Abstract
The study of the respiratory microbiota has revealed that the lungs of healthy and diseased individuals harbour distinct microbial communities. Imbalances in these communities can contribute to the pathogenesis of lung disease. How these imbalances occur and establish is largely unknown. This review is focused on the genetically inherited condition of Cystic Fibrosis (CF). Understanding the microbial and host-related factors that govern the establishment of chronic CF lung inflammation and pathogen colonisation is essential. Specifically, dissecting the interplay in the inflammation–pathogen–host axis. Bile acids are important host derived and microbially modified signal molecules that have been detected in CF lungs. These bile acids are associated with inflammation and restructuring of the lung microbiota linked to chronicity. This community remodelling involves a switch in the lung microbiota from a high biodiversity/low pathogen state to a low biodiversity/pathogen-dominated state. Bile acids are particularly associated with the dominance of Proteobacterial pathogens. The ability of bile acids to impact directly on both the lung microbiota and the host response offers a unifying principle underpinning the pathogenesis of CF. The modulating role of bile acids in lung microbiota dysbiosis and inflammation could offer new potential targets for designing innovative therapeutic approaches for respiratory disease.
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Henen S, Denton C, Teckman J, Borowitz D, Patel D. Review of Gastrointestinal Motility in Cystic Fibrosis. J Cyst Fibros 2021; 20:578-585. [PMID: 34147362 DOI: 10.1016/j.jcf.2021.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023]
Abstract
Gastrointestinal manifestations in patients with cystic fibrosis (CF) are extremely common and have recently become a research focus. Gastrointestinal (GI) dysfunction is poorly understood in the CF population, despite many speculations including the role of luminal pH, bacterial overgrowth, and abnormal microbiome. Nevertheless, dysmotility is emerging as a possible key player in CF intestinal symptoms. Our review article aims to explore the sequelae of defective cystic fibrosis transmembrane conductance regulator (CFTR) genes on the GI tract as studied in both animals and humans, describe various presentations of intestinal dysmotility in CF, review newer diagnostic motility techniques including intraluminal manometry, and review the current literature regarding the potential role of dysmotility in CF-related intestinal pathologies.
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Affiliation(s)
- Sara Henen
- Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, 1465 S Grand Blvd, St. Louis, MO 63104.
| | - Christine Denton
- Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, 1465 S Grand Blvd, St. Louis, MO 63104
| | - Jeff Teckman
- Interim Chair, Department of Pediatrics, Professor of Pediatrics and Biochemistry, Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, 1465 S Grand BLVD, St. Louis, MO 63104.
| | - Drucy Borowitz
- Emeritus Professor of Clinical Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, 1001 Main Street, Buffalo, NY, 14203.
| | - Dhiren Patel
- Associate Professor and Medical Director, Neurogastroenterology and Motility Program, Department of Pediatrics, Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, 1465 S Grand Blvd, St. Louis, MO 63104.
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Abstract
Proton pump inhibitors (PPIs) are amongst the most commonly prescribed drugs in infants and children with the last decades witnessing a dramatic rise in their utilization. Although PPIs are clearly effective when used appropriately and have been regarded as safe drugs, there is growing evidence regarding their potential adverse effects. Although, largely based on adult data it is clear that many of these are also relevant to pediatrics. PPI use potentially affects gastrointestinal microbiota composition and function, decreases defence against pathogens resulting in increased risk for infections, interferes with absorption of minerals and vitamins leading to specific deficiencies and increased risk for bone fractures as well as interferes with protein digestion resulting in increased risk of sensitization to allergens and development of allergic diseases and eosinophilic esophagitis. An association with gastric, liver and pancreatic cancer has also been inferred from adult data but is tenuous and causation is not proven. Overall, evidence for these adverse events is patchy and not always compelling. Overall, the use of PPIs, for selected indications with a good evidence base, has significant potential benefit but carries more caution in infants and children. Pediatricians should be aware of the concerns regarding the potential adverse events associated with their use.
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Bongiovanni A, Manti S, Parisi GF, Papale M, Mulè E, Rotolo N, Leonardi S. Focus on gastroesophageal reflux disease in patients with cystic fibrosis. World J Gastroenterol 2020; 26:6322-6334. [PMID: 33244195 PMCID: PMC7656210 DOI: 10.3748/wjg.v26.i41.6322] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/22/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder in cystic fibrosis (CF), and based on various studies, its prevalence is elevated since childhood. There are several pathogenetic mechanisms on the basis of association between CF and GERD. However, there are no specific guidelines for GERD in CF patients, so diagnosis is based on guidelines performed on patients not affected by CF. The aim of this review is to provide the pathophysiology, diagnostic and therapeutic options, complications, and future directions in the management of GERD patients with CF.
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Affiliation(s)
- Annarita Bongiovanni
- Department of Clinical and Experimental Medicine, Pediatric Respiratory Unit, San Marco Hospital, University of Catania, Catania 95123, Italy
| | - Sara Manti
- Department of Clinical and Experimental Medicine, Pediatric Respiratory Unit, San Marco Hospital, University of Catania, Catania 95123, Italy
| | - Giuseppe Fabio Parisi
- Department of Clinical and Experimental Medicine, Pediatric Respiratory Unit, San Marco Hospital, University of Catania, Catania 95123, Italy
| | - Maria Papale
- Department of Clinical and Experimental Medicine, Pediatric Respiratory Unit, San Marco Hospital, University of Catania, Catania 95123, Italy
| | - Enza Mulè
- Department of Clinical and Experimental Medicine, Pediatric Respiratory Unit, San Marco Hospital, University of Catania, Catania 95123, Italy
| | - Novella Rotolo
- Department of Clinical and Experimental Medicine, Pediatric Respiratory Unit, San Marco Hospital, University of Catania, Catania 95123, Italy
| | - Salvatore Leonardi
- Department of Clinical and Experimental Medicine, Pediatric Respiratory Unit, San Marco Hospital, University of Catania, Catania 95123, Italy
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Slae M, Wilschanski M. Cystic fibrosis and the gut. Frontline Gastroenterol 2020; 12:622-628. [PMID: 34917319 PMCID: PMC8640436 DOI: 10.1136/flgastro-2020-101610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 02/04/2023] Open
Abstract
Cystic fibrosis (CF) is a recessive disease caused by mutations in the CF transmembrane conductance regulator (CFTR) gene. The gene product, CFTR protein, has important manifestations in the intestine, pancreas and hepatobiliary system. Increased survival has caused CF to be primarily an adult disease today. Physicians must be knowledgeable as to the varied phenotype in the gastrointestinal tract. This review will outline the main gastrointestinal manifestations including a section on gastrointestinal malignancy in CF. Novel treatments treating the basic effect in CF are now being introduced and their effects on the gastrointestinal tract are discussed.
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Affiliation(s)
- Mordechai Slae
- Paediatric Gastroenterology, Hadassah University Hospital, Jerusalem, Israel
| | - Michael Wilschanski
- Paediatric Gastroenterology, Hadassah University Hospital, Jerusalem, Israel
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