The effect of cimetidine on maldigestion in cystic fibrosis

Cox, Kenneth L.; Isenberg, J. Nevin; Osher, Alan B; Dooley, Richard R.

doi:10.1016/s0022-3476(79)80609-5

Cited by 75 publications

(29 citation statements)

References 21 publications

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“…A recent Cochrane review concluded there was limited evidence that agents that reduce gastric acidity in people with CF are associated with improvement in gastrointestinal symptoms and fat absorption, and there was insufficient evidence to indicate whether they improved nutritional status or lung function. 102 Treatments have included cimetidine, both with conventional enzymes 96,99,100 and with enteric-coated, acid-resistant microspheres. 98 Ranitidine 4 mg/kg/day in two divided doses, maximum 300 mg b.d., 103 omeprazole 20 mg daily in adults and 0.7-1.4 mg/kg/day in children, 104,105 and lansoprazole 15 mg daily will improve absorption in many patients whose absorption is poorly controlled on 10,000 IU lipase per kg doses of enzymes.…”

Section: Failure To Control Gastrointestinal Symptomsmentioning

confidence: 99%

Diagnosis and Treatment of Intestinal Malabsorption in Cystic Fibrosis

Littlewood

Wolfe

Conway

2005

Pediatric Pulmonology

102

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Summary. Intestinal malabsorption is severe and of early onset in virtually all people who have cystic fibrosis. The main cause is deficiency of pancreatic enzymes. Bicarbonate deficiency, abnormal bile salts, mucosal transport problems, motility differences, and anatomical structural changes are other contributory factors. Effective treatment should allow a normal to high-fat diet to be taken, control symptoms, correct malabsorption, and achieve a normal nutritional state and growth. Appropriate pancreatic enzyme replacement therapy will achieve normal or near-normal absorption in most people with cystic fibrosis. Early identification and treatment of intestinal malabsorption is critical to achieving optimal nutritional status. The occurrence of fibrosing colonopathy in a few patients on very high doses of those enzymes which have the copolymer Eudragit L30 D55 in their covering resulted in guidelines in the UK to avoid doses equivalent to more than 10,000 IU lipase per kg per day, and also to avoid preparations containing this copolymer in children and adolescents. For patients not responding to 10,000 IU lipase per kg per day review of adherence to treatment, change of enzyme preparation, variation in time of administration, and reduction in gastric acid may improve absorption. The importance of early investigation to exclude other gastrointestinal disorders as a cause of the patient's symptoms, rather than merely increasing the dose of enzymes, is stressed. With modern pancreatic enzymes in doses up to or only slightly in excess of 10,000 IU lipase per kg per day, adequate control of gastrointestinal symptoms and absorption can be achieved, and a normal nutritional state and growth rate maintained in most people with cystic fibrosis.

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Section: Failure To Control Gastrointestinal Symptomsmentioning

confidence: 99%

Diagnosis and Treatment of Intestinal Malabsorption in Cystic Fibrosis

Littlewood

Wolfe

Conway

2005

Pediatric Pulmonology

102

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“…Inactivation in the stomach and low duodenal pH are the main reasons that only as little as 8% of the lipase given in pancreatic supplements reaches the ligament of Treitz (65)(66)(67). The effectiveness of pancreatic supplements improves after reduction of acid secretion by cimetidine (68)(69)(70)(71), but even under these conditions there is marked inactivation of pancreatic lipase (72,73). Our study suggests that lingual lipase might provide better therapy for the prevention of steatorrhea in CF.…”

Section: Discussionmentioning

confidence: 99%

Lingual lipase in cystic fibrosis. Quantitation of enzyme activity in the upper small intestine of patients with exocrine pancreatic insufficiency.

Abrams¹,

Hamosh²,

Hubbard³

et al. 1984

J. Clin. Invest.

108

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“…Cimetidine supplementation has been reported to eliminate steatorrhea [2], to decrease it [2, 25, 26, 27, 28], or to have no effect [21, 29], when added to conventional enzyme preparations. Cimetidine has also been shown to eliminate steatorrhea when given together with a microencapsulated compound [30].…”

Section: Failure To Respondmentioning

confidence: 99%

What to Do when a Patient with Exocrine Pancreatic Insufficiency Does Not Respond to Pancreatic Enzyme Substitution

Lankisch

1999

Digestion

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In the majority of patients, pancreatin microsphere preparations containing 25,000–40,000 FIP units of lipase will lead to a clinical improvement and reduction of steatorrhea in patients with exocrine pancreatic insufficiency. In patients failing to respond, the following stepwise procedure is recommended: increasing enzyme dosage; checking the patient’s compliance; reevaluating the diagnosis; and as a last resort to decrease fat intake or adding H₂-blockers or proton pump inhibitors. Although this stepwise procedure is time-consuming, it is necessary to prevent in patients not responding to pancreatic enzyme substitution the development of late complications of exocrine pancreatic insufficiency.

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The effect of cimetidine on maldigestion in cystic fibrosis

Cited by 75 publications

References 21 publications

Diagnosis and Treatment of Intestinal Malabsorption in Cystic Fibrosis

Diagnosis and Treatment of Intestinal Malabsorption in Cystic Fibrosis

Lingual lipase in cystic fibrosis. Quantitation of enzyme activity in the upper small intestine of patients with exocrine pancreatic insufficiency.

What to Do when a Patient with Exocrine Pancreatic Insufficiency Does Not Respond to Pancreatic Enzyme Substitution

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