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Use the Right GI Medications 

Here are some of the most important things to know and remember about your GI medications.

 
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Stay Tuned

Believe it or not, enzyme capsules are such an old medicine that they were on the market before the FDA existed!

Recently, the FDA has reviewed pancreatic enzyme supplements and many are now better and safer than ever before. 

New technologies are being developed to study acid in the intestines.

There is now a sensor pill that you can swallow that measures the acid, and this may help us understand what’s going on in the GI tract of people with CF. In the past we just had to make guesses.

 
Enzymes: Take Them Every Time You Eat   

Most people with CF need to take pancreatic enzyme capsules with every meal and snack.

Look on the side of your enzyme bottle. It lists the amount of lipase, protease and amylase. Lipase digests fat, protease digests protein and amylase digests starch.

Unless a snack is PURE SUGAR (such as a clear popsicle, sucking candy or fruit juice), you need to take your enzymes so the body can digest the nutrients.

Many people have a fixed dose — for example, a certain number of capsules with each meal, half that number with a snack. Others increase their dose if they eat a meal that has lots of fat in it, such as a pepperoni pizza and chicken wings in blue cheese sauce.

If you don’t digest food properly by taking pancreatic enzyme pills, the poorly digested fat or protein or starch sits in your intestines, and there it encourages gas to form, which can cause pain and may cause unpleasant aromas later.

What Else You Can Do 

  • Don’t put your enzymes where they can get hot, such as on a sunny windowsill or in the glove compartment of a car in warm weather. This causes the enzymes to spoil and stop working. 

  • If you are away from your house, you’ll need to think about ways to have enzymes available no matter where you are. Should you keep them in a drawer at work? In your backpack or purse? In your car in a thermal lunch carrier? Enzyme capsules don’t need to be kept cold, they just shouldn’t get too hot. Do what works for you.

  • Learn more about pancreatic enzyme replacement.

GERD or “Acid Reflux” Treatments 

The stomach makes acid. This acid can leak back from the stomach into the esophagus. This is called heartburn, acid reflux or gastroesophageal reflux disease (GERD in medical talk).

Coughing can make this worse, so people with cystic fibrosis may be more likely to have GERD. The acid reflux can cause injury to the esophagus. It also can trigger cough or asthma.

Your CF care team may prescribe a medicine for this problem. These include, but are not limited to: 

“Proton pump inhibitors”* “H2 blockers”*
Prilosec® (omeprazole) Zantac® (ranitidine)
Prevacid® (lansoprazole) Pepcid® (famotidine)
Nexium® (esomeprazole) Axid® (nizatidine)

*To learn more about these drugs, go to Medline Plus.

Old-fashioned over-the-counter antacids, like Maalox® or Mylanta®, may be used along with, not instead of, the proton-pump inhibitors.

Other ways to treat GERD include: 

  • Not eating big meals just before lying down;
  • Avoiding certain spicy foods, alcohol or mints and  
  • Lifting the head of your bed with blocks to keep your body sloping down.

There also are some surgical procedures that tighten the spot where the esophagus meets the stomach. Your physician may want to refer you to a stomach specialist (gastroenterologist) if this becomes an ongoing problem.

Constipation Treatments 

In addition to making the digestive juices, the pancreas normally squirts 1 to 2 quarts of fluid into the intestines every day. That's right, 1 to 2 quarts! The production of this intestinal fluid is often impaired in people with CF, even if they make a normal amount of the pancreatic enzymes.

As in the lungs, the intestines in CF can make thick mucus. If you have this thick mucus but not enough fluid in the intestines, you can get constipated or even develop a bowel obstruction. This can be a serious problem and may lead to surgery if it becomes very stubborn.

Keep these problems in mind if you are having abdominal pain and you are having a hard time moving your bowels. Drinking plenty of fruit juices (not just water) may help. The over-the-counter medication polyethylene glycol is very effective in reversing hard stools and constipation. This is available at most pharmacies and grocery stores. Brand names include MiraLAX®, GoLYTELY® and NuLYTELY® but generics also are available.

Two CF conditions that make it hard to move your bowels.  

  • Constipation is when thick poop sits in your large intestine. People with CF can be having bowel movements every day and still have LOTS of poop backed up in their large intestine. Extra fluids, more fiber in your diet and regular exercise can help prevent this. If you have constipation, talk to your CF doctor about using a daily medicine like MiraLAXor GlycoLax to keep fluid in your intestines.

  • Distal Intestinal Obstruction Syndrome (DIOS) is a blockage or bowel obstruction, seen only in people with CF, when thick poop sits right at the spot where the small intestine joins the large intestine. This can be severe enough to totally block your intestines or it can be “low grade,” when you have pain but aren’t super sick.

    To learn more, watch the Webcast, "Constipation and DIOS in CF." 

Mild cases of DIOS may be treated at home with MiraLAX or GoLYTELY. Severe DIOS needs to be treated in the hospital.

Treatments can include an NG tube (NG stands for nasogastric), which goes through your nose and into your stomach to drain your intestine. Sometimes special enemas are used. Other treatments could include large-volume medicines such as polyethylene glycol (GoLYTELY, MiraLAX or NuLYTELY), which may either be drunk or given through an NG tube.

These medicines suck water into the intestines and wash through the intestines to move blockages. If you have ever had DIOS, you probably need to be on a regular medicine every day to help your intestines move along.

“Good Bacteria” Treatments 

Everyone’s intestines have bacteria, and most of them are in the large intestine. We normally live in harmony with the bacteria. But CF can change that balance. 

With CF, instead of having a wide variety of healthy bacteria, the intestines sometimes have only one or two strains. Also, instead of staying in the large intestine, bacteria may be up in the small intestine where they can compete with our bodies for food. The bacteria can create gas and cause inflammation to the lining of the intestine, leading to pain and/or weight loss.

Your CF doctor may want to do a special test to look for “bacterial overgrowth” in the small intestine or may want to treat you with a special antibiotic to fix this problem (which can come and go).

You may also want to consider daily use of over-the-counter products called “probiotics.” These are “good bacteria” that you can take in pill form or added to foods such as yogurt.

To learn more, watch the Webcast, "Constipation and DIOS in CF." 

What Else You Can Do 

Things you can do to keep your GI tract health as good as possible:

  • Exercise regularly — it’s good for your lungs and for your digestion. 
  • Think actively about how to have enzymes available every time you eat. 
  • Be sure to take CF-specific vitamins every day — best to take them with meals, so the pancreatic enzymes will help the vitamins get into your body. 
  • Eat well and take time to enjoy eating. 
  • Stay hydrated!

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Updated 07/20/12