Skip to main content

Advertisement

Log in

Cystic fibrosis colonopathy

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

An epidemic of fibrosing colonopathy, a new disease caused by the prolonged administration of excessive doses of pancreatic enzymes, was first reported in 1994. More than 60 cases were known to occur worldwide before dosage guidelines were enforced. Predisposing factors were young age, previous intestinal surgery, meconium ileus equivalent, and use of H2 blockers, corticosteroids, and DNase. Abnormal features included foreshortened colon, strictures, marked submucosal fibrosis, ascites, and nodular hyperplasia of the liver. Histologic examination showed eosinophilia, mild cryptitis, epithelial regeneration, and widespread interruption of the muscularis mucosa. These findings are distinct from, but share many of the features of, those of Crohn’s’s disease and ischemic bowel disease. The pathogenic mechanisms remain unknown.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Smyth RL, van Velzen D, Smyth AR, et al.: Strictures of ascending colon in cystic fibrosis and high-strength pancreatic enzymes. Lancet 1994, 343:85–86.

    Article  PubMed  CAS  Google Scholar 

  2. Freiman JR, FitzSimmons SC: Colonic strictures in patients with cystic fibrosis: results of a survey of 114 cystic fibrosis care centers in the United States. J Pediatr Gastroenterol Nutr 1996, 22:153–156.

    Article  PubMed  CAS  Google Scholar 

  3. Smyth RL, Ashby D, O‘Hea U, et al.: Fibrosing colonopathy in cystic fibrosis: results of a case-control study. Lancet 1995, 346:1247–1251.

    Article  PubMed  CAS  Google Scholar 

  4. FitzSimmons SC, Burkhart GA, Borowitz D, et al.: High dose pancreatic enzyme supplements and fibrosing colonopathy in children with cystic fibrosis. N Engl J Med 1997, 336:1283–1289. This is a comprehensive case-control study of the US experience.

    Article  PubMed  CAS  Google Scholar 

  5. Borowitz DS, Grand RJ, Durie PR et al.: Use of pancreatic enzyme supplements for patients with cystic fibrosis in the context of fibrosing colonopathy. J Pediatr 1995, 127:681–684.

    Article  PubMed  CAS  Google Scholar 

  6. Lloyd-Still JD: Colonopathy in a non cystic fibrosis patient: from excess pancreatic enzymes. J Pediatr Gastroenterol Nutr 1996, 23:583–585.

    Article  PubMed  CAS  Google Scholar 

  7. van Velzen D, Ball LM, Dezfulian AR, et al.: Comparative and experimental pathology of fibrosing colonopathy. Postgrad Med J 1996, 72(suppl 2):39–48. Although the experimental hypotheses have not been confirmed, this is an interesting article comparing different colonic diseases that must be distinguished from fibrosing colonopathy.

    Google Scholar 

  8. Pawel BR, de Chadarevian JP, Franco ME: The pathology of fibrosing colonopathy of cystic fibrosis: a study of 12 cases and review of the literature. Hum Pathol 1997, 28:395–399. Here are detailed descriptions of various cystic fibrosis findings (prestricture lesions to total colonic involvement) from a center with some of the most extensive clinical experience of this disease.

    Article  PubMed  CAS  Google Scholar 

  9. Lloyd-Still JD: Editorial: cystic fibrosis and colonic strictures: a new " iatrogenic" disease. J Clin Gastroenterol 1995, 21:2–5.

    Article  PubMed  CAS  Google Scholar 

  10. Schwarzenberg SJ, Wielinski CL, Shamieh I, et al.: Cystic fibrosis-associated colitis and fibrosing colonopathy (CFCFC): presentation, clinical course, and management. J Pediatr 1995, 127:565–570.

    Article  PubMed  CAS  Google Scholar 

  11. Prestridge L, Barton Rogers B, Pritchard M, et al.: Diffuse fibrosis of the colon complicating cystic fibrosis. J Pediatr Gastrenterol Nutr 1996, 22:219–224.

    Article  CAS  Google Scholar 

  12. Lebenthal E: High strength pancreatic exocrine enzyme capsules associated with colonic strictures in patients with cystic fibrosis: "more is not necessarily better." J Pediatr Gastroenterol Nutr 1994, 18:423–425.

    Article  PubMed  CAS  Google Scholar 

  13. Durie PR, Bell L, Linton W, et al.: Effect of cimetidine and sodium bicarbonate on pancreatic replacement therapy in cystic fibrosis. Gut 1980, 21:778–786.

    PubMed  CAS  Google Scholar 

  14. Knabe N, Zak M, Hansen A, et al.: Extensive pathological changes of the colon in cystic fibrosis and high-strength pancreatic enzymes. Lancet 1994, 343:1230.

    Article  PubMed  CAS  Google Scholar 

  15. Stevens JC, Maguiness KM, Hollingsworth J, et al.: Pancreatic enzyme supplementation in cystic fibrosis patients before and after fibrosing colonopathy. J Pediatr Gastroenterol Nutr 1998, 26:80–84.

    Article  PubMed  CAS  Google Scholar 

  16. Collins MH, Azzarelli B, West KW, et al.: Neuropathy and vasculopathy in colonic strictures from children with cystic fibrosis. J Pediatr Surg 1996, 31:945–950.

    Article  PubMed  CAS  Google Scholar 

  17. Zerin JM, Kuhn-Fulton J, White SJ, et al.: Colonic strictures in children with cystic fibrosis. Radiology 1995, 194:223–226.

    PubMed  CAS  Google Scholar 

  18. Reichard KW, Vinocur CD, Franco M, et al.: Fibrosing colonopathy in children with cystic fibrosis. J Pediatr Surg 1997, 32:237–242.

    Article  PubMed  CAS  Google Scholar 

  19. Pettei MJ, Leonidas JC, Levine JJ, et al.: Pancolonic disease in cystic fibrosis and high dose enzyme therapy. J Pediatr 1994, 125:587–589.

    Article  PubMed  CAS  Google Scholar 

  20. Pohl M, Krackhardt B, Posselt HG, et al.: Ultrasound studies of the intestinal wall in patients with cystic fibrosis. J Pediatr Gastroenterol Nutr 1997, 25:317–320.

    Article  PubMed  CAS  Google Scholar 

  21. MacSweeney EJ, Oades PJ, Buchdahl R, et al.: Relation of thickening of colon wall to pancreatic-enzyme treatment in cystic fibrosis. Lancet 1995, 345:752–756.

    Article  CAS  Google Scholar 

  22. Charron M, Fernando del Rosario J, Kocoshis S: Distribution of acute bowel inflammation determined by technetium-labeled white blood cells in children with inflammatory bowel disease. Inflamm Bowel Dis 1998, 4:84–88.

    Article  PubMed  CAS  Google Scholar 

  23. Croft NM, Marshall TG, Ferguson A: Gut inflammation in children with cystic fibrosis on high-dose enzyme supplements. Lancet 1995, 346:1265–1267.

    Article  PubMed  CAS  Google Scholar 

  24. Followill DS, Kester D, Travis EL: Histological changes in mouse colon after single and split-dose radiation. Radiat Res 1993,136:280–288.

    Article  PubMed  CAS  Google Scholar 

  25. Lloyd-Still JD: Crohn’s’s disease and cystic fibrosis. Dig Dis Sci 1994, 39:880–885.

    Article  PubMed  CAS  Google Scholar 

  26. Lloyd-Still JD, Uhing MR, Arango VA, et al.: The effect of intestinal permeability on pancreatic enzyme induced enteropathy in the rat. J Pediatr Gastroenterol Nutr 1998, 26:489–495.

    Article  PubMed  CAS  Google Scholar 

  27. Kimura RE, Arango V, Lloyd-Still JD: Indomethacin and pancreatic enzymes synergistically damage intestine of rats. Dig Dis Sci 1998, 43:2322–2332. Report on an interesting animal model for this disease.

    Article  PubMed  CAS  Google Scholar 

  28. Powell, CJ: Colonic toxicity from pancreatitis: a contemporary safety issue. Lancet 1999, 353:911–915. Comprehensive review of the subject.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lloyd-Still, J.D., Beno, D.W.A. & Kimura, R.M. Cystic fibrosis colonopathy. Curr Gastroenterol Rep 1, 231–237 (1999). https://doi.org/10.1007/s11894-999-0040-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-999-0040-4

Keywords

Navigation