Proton-Pump Inhibitors and Fat Absorption in Cystic Fibrosis and Pancreatic Insufficiency: A Randomized Crossover Pilot Trial.

Autor: Phillips AE; Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Brownell JN; Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, 3500 Civic Center Blvd., Philadelphia, PA, 19104, USA. brownellj@chop.edu.; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. brownellj@chop.edu., Tindall A; Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, 3500 Civic Center Blvd., Philadelphia, PA, 19104, USA., Kiernan BD; Division of Gastroenterology, Hepatology, and Nutrition, New York University, New York, NY, USA., Patel D; Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, MO, USA., Gelfond D; WNY Pediatric Gastroenterology and Nutrition, DGRD, Buffalo, NY, USA., Stallings VA; Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, 3500 Civic Center Blvd., Philadelphia, PA, 19104, USA.; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Jazyk: angličtina
Zdroj: Digestive diseases and sciences [Dig Dis Sci] 2024 Nov 13. Date of Electronic Publication: 2024 Nov 13.
DOI: 10.1007/s10620-024-08728-8
Abstrakt: Background: Dietary fat malabsorption contributes to poor nutritional status in patients with cystic fibrosis (CF) and exocrine pancreatic insufficiency (EPI). Prescribing gastric acid-reducing agents such as proton-pump inhibitors (PPI) as an adjunct to pancreatic enzyme replacement therapy (PERT) to improve dietary fat absorption has been accepted in clinical practice despite limited evidence.
Aims: This was a pilot randomized, double-blind, placebo-controlled crossover trial of subjects aged 12 and older with CF and EPI assessed on placebo and omeprazole to determine if PPI improved the efficacy of PERT as indicated by measures of dietary fat absorption.
Methods: Fat malabsorption via stool coefficient of fat absorption (CFA) and malabsorption blood test (MBT), gastrointestinal pH (wireless motility capsule [WMC]), and quality of life (QOL) were assessed after 14 days on both placebo or PPI (omeprazole).
Results: Total 19 subjects enrolled, 13 were randomized, and 9 provided paired results on placebo and PPI. The 3 subject results for CFA were as follows: 1 increased, 1 decreased, and 1 was within the reference range in both tests for fat absorption. For 9 MBT subjects, 7 decreased and 2 increased fat absorption. For the 4 WMC studies, no change in transit times, nor in pH profiles were noted. No differences were seen in the domains of the two QOL questionnaires comparing placebo and PPI.
Conclusions: These limited descriptive pilot study results in participants with CF and EPI on PERT evaluated by stool, blood, and QOL tests did not suggest improvement in fat absorption attributable to PPI.
Competing Interests: Declarations Conflict of interest All authors disclose they have no conflicts of interest related to this project and manuscript. The funding sources had no role in study design, analysis, or drafting of the manuscript.
(© 2024. The Author(s).)
Databáze: MEDLINE
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