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Association between faecal pH and fat absorption in children with cystic fibrosis on a controlled diet and enzyme supplements dose
Pediatric Research ( IF 3.6 ) Pub Date : 2020-04-04 , DOI: 10.1038/s41390-020-0860-3
Joaquim Calvo-Lerma 1, 2 , Maria Roca 1 , Mieke Boon 3 , Carla Colombo 4 , Barbara de Koning 5 , Victoria Fornés-Ferrer 6 , Etna Masip 1 , Maria Garriga 7 , Anna Bulfamante 4 , Andrea Asensio-Grau 2 , Ana Andrés 2 , Kris de Boeck 3 , Jessie Hulst 8 , Carmen Ribes-Koninckx 1
Affiliation  

Background Despite treatment with pancreatic enzyme replacement therapy (PERT), patients with cystic fibrosis (CF) can still suffer from fat malabsorption. A cause could be low intestinal pH disabling PERT. The aim of this study was to assess the association between faecal pH (as intestinal pH surrogate) and coefficient of fat absorption (CFA). Additionally, faecal free fatty acids (FFAs) were quantified to determine the amount of digested, but unabsorbed fat. Methods In a 24-h pilot study, CF patients followed a standardised diet with fixed PERT doses, corresponding to theoretical optimal doses determined by an in vitro digestion model. Study variables were faecal pH, fat and FFA excretion, CFA and transit time. Linear mixed regression models were applied to explore associations. Results In 43 patients, median (1st, 3rd quartile) faecal pH and CFA were 6.1% (5.8, 6.4) and 90% (84, 94), and they were positively associated ( p < 0.001). An inverse relationship was found between faecal pH and total fat excretion ( p < 0.01), as well as total FFA ( p = 0.048). Higher faecal pH was associated with longer intestinal transit time ( p = 0.049) and the use of proton pump inhibitors ( p = 0.009). Conclusions Although the clinical significance of faecal pH is not fully defined, its usefulness as a surrogate biomarker for intestinal pH should be further explored. Impact Faecal pH is a physiological parameter that may be related to intestinal pH and may provide important physiopathological information on CF-related pancreatic insufficiency. Faecal pH is correlated with fat absorption, and this may explain why pancreatic enzyme replacement therapy is not effective in all patients with malabsorption related to CF. Use of proton pump inhibitors is associated to higher values of faecal pH. Faecal pH could be used as a surrogate biomarker to routinely monitor the efficacy of pancreatic enzyme replacement therapy in clinical practice. Strategies to increase intestinal pH in children with cystic fibrosis should be targeted.

中文翻译:

控制饮食和酶补充剂剂量的囊性纤维化儿童粪便 pH 值与脂肪吸收之间的关系

背景 尽管使用胰酶替代疗法 (PERT) 进行治疗,囊性纤维化 (CF) 患者仍可能患有脂肪吸收不良。一个原因可能是肠道 pH 值过低导致 PERT 失效。本研究的目的是评估粪便 pH 值(作为肠道 pH 值替代物)与脂肪吸收系数 (CFA) 之间的关联。此外,粪便游离脂肪酸 (FFA) 被量化以确定已消化但未吸收的脂肪量。方法 在一项 24 小时的试点研究中,CF 患者遵循具有固定 PERT 剂量的标准化饮食,对应于由体外消化模型确定的理论最佳剂量。研究变量是粪便 pH 值、脂肪和 FFA 排泄、CFA 和转运时间。应用线性混合回归模型来探索关联。结果 在 43 名患者中,中位数(第 1 名,第三四分位数)粪便 pH 值和 CFA 分别为 6.1% (5.8, 6.4) 和 90% (84, 94),并且它们呈正相关 (p < 0.001)。发现粪便 pH 值与总脂肪排泄量 (p < 0.01) 以及总 FFA (p = 0.048) 之间呈负相关。较高的粪便 pH 值与较长的肠道转运时间 (p = 0.049) 和使用质子泵抑制剂 (p = 0.009) 相关。结论 尽管粪便 pH 值的临床意义尚未完全确定,但应进一步探索其作为肠道 pH 值替代生物标志物的有用性。影响 粪便 pH 值是一个生理参数,可能与肠道 pH 值有关,并可能为 CF 相关的胰腺功能不全提供重要的病理生理信息。粪便 pH 值与脂肪吸收有关,这或许可以解释为什么胰酶替代疗法对所有与 CF 相关的吸收不良的患者都无效。质子泵抑制剂的使用与较高的粪便 pH 值有关。粪便 pH 值可用作替代生物标志物,在临床实践中常规监测胰酶替代疗法的疗效。增加囊性纤维化儿童肠道 pH 值的策略应该是有针对性的。
更新日期:2020-04-04
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