Fibrosing Colonopathy

This disease was first described in CF patients from Britain in 1994 in a report from Dr. R. Smyth. About 2 years before the report, very high dose supplemental pancreatic enzyme products became available on the market, with lipase content of 20,000 or 25,000 U/capsule.Although this was done to limit the number of capsules the patient had to take, these higher lipase capsules could more easily provide patients with exceptionally high lipase doses. This was especially true when patients made little change in the number of capsules when switching from a lower dosage to a higher dosage. This initial report described five children with CF who developed strictures, chronic obstructive symptoms, and eventually underwent colectomy. The pathologic description of the surgical specimens was marked submu-cosal fibrosis primarily affecting the proximal colon. Subsequent work indicates that before that final stage is reached, the endoscopic appearance may be that of a few nonspecific ulcers. Again the microscopic appearance of mucosal biopsies shows nonspecific changes with fairly marked eosinophilia, but no granulomas. The epidemiology of the disease from a good case-control study in the United States points to the dose of pancreatic enzyme as the causative factor. The fibrosis is the final outcome for colons that have been irreparably damaged by very high dose enzymes. Based on observations in the rat, one hypothesis about the nature of the injury involves the increased intestinal permeability in CF patients (Mack et al, 1992), in addition to high dose pancreatic enzymes leading to enteropathy, fibrosis, and possibly hepatic injury (Lloyd-Still et al, 1998). Current recommendations limit the dose of enzymes that patients ingest. The maximum dose should be 2,500 Units lipase per kg per meal or 10,000 Units lipase per kg per day. All the currently marketed enzymes function best at a > pH 6.5. Due to the loss of bicarbonate production by the pancreas to optimize duodenal pH, a PPI may assist with both the activity of the enzymes in the proximal small intestine, and improving intestinal permeability (Hendriks et al, 2001) by increasing tight junction function. Although reports of this entity have declined, ongoing vigilance should be maintained.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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