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Delayed Small Bowel Transit in Children With Cystic Fibrosis and Pancreatic Insufficiency

Rovner, Alisha J.*; Schall, Joan I.*; Mondick, John T.; Zhuang, Hongming; Mascarenhas, Maria R.*

Journal of Pediatric Gastroenterology and Nutrition: July 2013 - Volume 57 - Issue 1 - p 81–84
doi: 10.1097/MPG.0b013e318290d112
Original Articles: Gastroenterology

Objective: Gastrointestinal disturbances are common in people with cystic fibrosis (CF); however, motility studies in this population have yielded inconsistent results. This study examined gastric emptying (GE) and small bowel transit (SBT) time in children with CF and pancreatic insufficiency compared with a healthy adult reference group.

Methods: Participants consumed an 8-ounce liquid test meal (approximately 550 calories, 32 g of fat) labeled with 300 μCi 99m technetium (Tc) sulfur colloid. Subjects with CF received a standard dose of pancreatic enzymes before consuming the test meal. GE and SBT were measured using a standard nuclear medicine scan. GE was determined after correcting for 99mTc decay in both anterior and posterior images. SBT was determined by following the movement of the tracer from the stomach to the cecum. The percentage arrival of total small bowel activity at the terminal ileum and cecum/ascending colon at 6 hours was used as an index of SBT. A 1-way analysis of covariance was performed for comparisons between groups after adjustment for age, sex, and body mass index.

Results: Subjects with CF (n = 16) had similar GE compared with the healthy reference group (n = 12); however, subjects with CF had significantly prolonged SBT time. At 6 hours, 37.2% ± 25.4% (95% CI 23.7–50.7) of the tracer reached the terminal ileum and colon compared with 68.6% ± 13.1% (95% CI 60.2–76.9) for the reference group (P < 0.001). After controlling for sex, age, and body mass index, this difference remained statistically significant (F = 12.06, adjusted R 2 = 0.44, P < 0.002).

Conclusions: Children with CF and pancreatic insufficiency had unaltered GE but delayed SBT time when taking pancreatic enzymes.

*Division of Gastroenterology, Hepatology and Nutrition

Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA

Metrum Institute, Tariffville, CT.

Address correspondence and reprint requests to Maria R. Mascarenhas, MBBS, Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA 19104 (e-mail:

Received 8 April, 2012

Accepted 4 March, 2013

The study was supported in part by the Clinical and Translational Research Center (UL1RR024134) and Nutrition Center at The Children's Hospital of Philadelphia and Solvay Pharmaceuticals, Inc.

The authors report no conflicts of interest.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,