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Comparison of gastrointestinal pH in cystic fibrosis and healthy subjects

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Abstract

The primary objective of this study was to define the pH conditions under which supplemental pancreatic enzyme preparations must function in the upper gastrointestinal tract. The hypothesis was that normal or greater gastric acid output in patients with cystic fibrosis (CF), combined with low pancreatic bicarbonate output, results in an acidic duodenal pH, compromising both dosage-form performance and enzyme activity. Gastrointestinal pH profiles were obtained in 10 CF and 10 healthy volunteers under fasting and postprandial conditions. A radiotelemetric monitoring method, the Heidelberg capsule, was used to continuously monitor pH. Postprandial duodenal pH was lower in CF than in healthy subjects, especially in the first postprandial hour (mean time greater than pH 6 was 5 min in CF, 11 min in healthy subjects,P<0.05). Based on the dissolution pH profiles of current enteric-coated pancreatic enzyme products, the duodenal postprandial pH in CF subjects may be too acidic to permit rapid dissolution of current enteric-coated dosage forms. However, the pH was above 4 more than 90% of the time on the average, suggesting that irreversible lipase inactivation in the duodenum is not likely to be a significant limitation to enzyme efficacy. Overall results suggest that slow dissolution of pH-sensitive coatings, rather than enzyme inactivation, may contribute to the failure of enteric-coated enzyme supplements to normalize fat absorption.

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Authors and Affiliations

  1. College of Pharmacy and Department of Pediatrics and Communicable Diseases, The University of Michigan, 48109-1065, Ann Arbor, Michigan

    Carole A. Youngberg MS, Rosemary R. Berardi PharmD, William F. Howatt MD, Martha L. Hyneck PharmD, Gordon L. Amidon PhD, James H. Meyer MD & Jennifer B. Dressman PhD

  2. Division of Gastroenterology, Sepulveda Veterans Administration Medical Center, Sepulveda, California

    Carole A. Youngberg MS, Rosemary R. Berardi PharmD, William F. Howatt MD, Martha L. Hyneck PharmD, Gordon L. Amidon PhD, James H. Meyer MD & Jennifer B. Dressman PhD

Authors
  1. Carole A. Youngberg MS
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  2. Rosemary R. Berardi PharmD
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  3. William F. Howatt MD
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  4. Martha L. Hyneck PharmD
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  5. Gordon L. Amidon PhD
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  6. James H. Meyer MD
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  7. Jennifer B. Dressman PhD
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Additional information

This study was supported by a Rackham Faculty Award, National Institutes of Health grant M-01RR0042, and the Cystic Fibrosis Foundation.

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Youngberg, C.A., Berardi, R.R., Howatt, W.F. et al. Comparison of gastrointestinal pH in cystic fibrosis and healthy subjects. Digest Dis Sci 32, 472–480 (1987). https://doi.org/10.1007/BF01296029

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  • DOI: https://doi.org/10.1007/BF01296029

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