Nutritional supplementation in treatment of cystic fibrosis of the pancreas

Lung infections associated with cystic fibrosis

While originally characterized as a collection of related syndromes, cystic fibrosis (CF) is now recognized as a single disease whose diverse symptoms stem from the wide tissue distribution of the gene product that is defective in CF, the ion channel and regulator, cystic fibrosis transmembrane conductance regulator (CFTR). Defective CFTR protein impacts the function of the pancreas and alters the consistency of mucosal secretions. The latter of these effects probably plays an important role in the defective resistance of CF patients to many pathogens. As the modalities of CF research have changed over the decades from empirical histological studies to include biophysical measurements of CFTR function, the clinical management of this disease has similarly evolved to effectively address the ever-changing spectrum of CF-related infectious diseases. These factors have led to the successful management of many CF-related infections with the notable exception of chronic lung infection with the gram-negative bacterium Pseudomonas aeruginosa. The virulence of P. aeruginosa stems from multiple bacterial attributes, including antibiotic resistance, the ability to utilize quorum-sensing signals to form biofilms, the destructive potential of a multitude of its microbial toxins, and the ability to acquire a mucoid phenotype, which renders this microbe resistant to both the innate and acquired immunologic defenses of the host.

Increasing calorie consumption in children with cystic fibrosis: replication with 2-year follow-up

Three mildly malnourished children with cystic fibrosis and their parents participated in a behavioral group-treatment program that focused on promoting and maintaining increased calorie consumption. Treatment included nutritional education, gradually increasing calorie goals, contingency management, and relaxation training, and was evaluated in a multiple baseline design across four meals. Children's calorie intake increased across meals, and total calorie intake was 32% to 60% above baseline at posttreatment. Increased calorie consumption was maintained at the 96-week follow-up (2 years posttreatment). The children's growth rates in weight and height were greater during the 2 years following treatment than the year prior to treatment. Increases in pace of eating and calories consumed per minute were also observed 1 year posttreatment. These findings replicated and extended earlier research supporting the efficacy of behavioral intervention in the treatment of malnutrition in children with cystic fibrosis.

Prostaglandin-induced diarrhoea

A child with chronic diarrhoea since birth responded to the prostaglandin synthetase inhibitors aspirin and indomethacin. During a period without treatment, raised levels of prostaglandins F2alpha and E2 were observed. No source for these raised prostaglandins was shown, and it is suggested that she may have an inborn defect of prostaglandin metabolism.

Prolonged nasogastric tube feeding in critically ill and surgical patients

Fifteen patients with varying diagnoses were fed via nasogastric tubes for between 7 and 41 days using a feed consisting of Caloreen (a glucose polymer) and Albumaid (a beef serum hydrolysate) with vitamin and mineral supplements. The feed proved nutritionally adequate and relatively free of complications. Diarrhoea was seen only in those patients receiving antibiotics by the nasogastric route. Codeine phosphate abolished this symptom in all patients. The constant drip method of administration proved efficient and time saving. Unlike prepacked preparations, the feed could be varied in composition to suit the clinical situation. This was of particular advantage in the intensive care context. The feed was relatively inexpensive.