Digestive and absorptive phase anomalies associated with the exocrine pancreatic insufficiency of cystic fibrosis

C. C. Roy, A. M. Weber, G. Lepage, Lesley J Smith, E. Levy

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

The pancreas has an enormous reserve capacity, and significant malabsorption usually signals complete absence of exocrine function. However, there is evidence that acid lipases of nonpancreatic origin play an important compensatory role. Complete duodenal hydrolysis of fat requires a series of complex interdependent physicochemical events involving pancreatic lipase, colipase, phospholipase A2, and bile salts in an environment where the pH must be close to neutrality. Lipolytic products must then be shuttled through the unstirred water layer to the surface of the microvillus membrane by ionized bile salts, which must be present in sufficient concentrations to form micelles. In pancreatic insufficiency, there is not only a defective lipolytic phase but also an impaired micellar phase. The output of bile salts is decreased because of increased fecal loss. Furthermore, a significant percentage of bile salts precipitate because the duodenum is acidic and there is a large predominance of glycine conjugates. Although much less work has been done on the absorptive phase of patients with pancreatic insufficiency, there is tentative evidence that defective phospholipid absorption, essential fatty acid deficiency, and protein malnutrition could impair the absorptive phase, particularly chylomicron formation. Although significant advances have been made in our understanding of factors responsible for malabsorption associated with pancreatic insufficiency, much remains to be done for the further delineation of defects. It is hoped that this will lead to further refinements of enzyme preparations and to new strategies of intervention.

Original languageEnglish
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume7
Issue numberSUPPL. 1
StatePublished - Jan 1 1988
Externally publishedYes

Fingerprint

Exocrine Pancreatic Insufficiency
bile salts
cystic fibrosis
Bile Acids and Salts
Cystic Fibrosis
malabsorption
Lipase
Colipases
Chylomicrons
chylomicrons
Protein Deficiency
kwashiorkor
Essential Fatty Acids
phospholipase A2
Phospholipases A2
Micelles
essential fatty acids
micelles
Microvilli
microvilli

ASJC Scopus subject areas

  • Food Science
  • Medicine (miscellaneous)
  • Gastroenterology
  • Histology
  • Pediatrics, Perinatology, and Child Health

Cite this

Digestive and absorptive phase anomalies associated with the exocrine pancreatic insufficiency of cystic fibrosis. / Roy, C. C.; Weber, A. M.; Lepage, G.; Smith, Lesley J; Levy, E.

In: Journal of Pediatric Gastroenterology and Nutrition, Vol. 7, No. SUPPL. 1, 01.01.1988.

Research output: Contribution to journalArticle

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