Digestive Diseases and Sciences

, Volume 58, Issue 8, pp 2275–2281 | Cite as

Intestinal pH and Gastrointestinal Transit Profiles in Cystic Fibrosis Patients Measured by Wireless Motility Capsule

  • Daniel Gelfond
  • Changxing Ma
  • Jack Semler
  • Drucy Borowitz
Original Article

Abstract

Background and Aims

The effect of the cystic fibrosis transmembrane conductance regulator protein (CFTR) defect in pancreatic insufficient (PI) patients with cystic fibrosis (CF) on the gastrointestinal pH profile is poorly defined. Adequate and efficient neutralization of the gastric acidity in the duodenum is important for nutrient absorption and timely release of pancreatic enzyme replacement therapy (PERT). We utilized a wireless motility capsule (WMC) to study intestinal pH profile and gastrointestinal transit profile in CF subjects.

Methods

WMC studies were done on ten adult CF patients with PI while off acid suppression medication and ten age, gender and BMI matched healthy controls. Mean pH over 1 min increments and area under the pH curve over 5 min increments was calculated for the first hour post gastric emptying. Paired t-test was used to compare means of the pH recordings, transit profiles and analysis of time interval required to reach and maintain pH >5.5 and 6.0.

Results

A statistically significant difference was observed between mean pH values during the first 23 min of small bowel transit (p < 0.05). In CF subjects, there was a significant delay in time interval required to reach and sustain pH 5.5 and pH 6.0 (p < 0.001), which is required for PERT dissolution. Only small bowel transit in CF subjects was noted to be significantly delayed (p = 0.004) without a compensatory increase in whole gut transit time.

Conclusions

We have demonstrated a significant delay in the small intestinal transit and a deficient buffering capacity required to neutralize gastric acid in the proximal small bowel of patients with CF.

Keywords

Cystic fibrosis pH profile CFTR PERT Small bowel transit Wireless motility capsule 

Abbreviations

CFTR

Cystic fibrosis transmembrane conductance regulator protein

CF

Cystic fibrosis

PERT

Pancreatic enzyme replacement therapy

WMC

Wireless motility capsule

PI

Pancreatic insufficiency

AUC

Area under the curve

GET

Gastric emptying time

SBTT

Small bowel transit time

CTT

Colon transit time

WGT

Whole gut transit time

BMI

Body mass index

Notes

Acknowledgments

The authors would like to thank Gregory E. Wilding for an early discussion on analytical methods of SmartPill data. This study was funded by a grant from Cystic Fibrosis Foundation Therapeutics, Inc. Funding #: BOROWI08A0.

Conflict of interest

Jack Semler is an employee of SmartPill Corporation and owns stock in the corporation. Daniel Gelfond, Changxing Ma and Drucy Borowitz have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Daniel Gelfond
    • 1
  • Changxing Ma
    • 2
  • Jack Semler
    • 3
  • Drucy Borowitz
    • 4
  1. 1.Department of Pediatrics, Digestive Diseases and Nutrition Center, Women and Children’s Hospital of BuffaloState University of New York at Buffalo School of Medicine and Biomedical SciencesBuffaloUSA
  2. 2.Department of BiostatisticsState University of New York at Buffalo School of Public Health and Health ProfessionsBuffaloUSA
  3. 3.SmartPill CorporationBuffaloUSA
  4. 4.Department of Pediatrics, Division of Pediatric Pulmonology, Women and Children’s Hospital of BuffaloState University of New York at Buffalo School of Medicine and Biomedical SciencesBuffaloUSA

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