The Digestive System

The digestive system includes all the organs involved in digesting the food you eat and absorbing the nutrients. This is also called the gastrointestinal (GI) system. 

Some of these organs make up the digestive tract. This is the route your food follows after you put it in your mouth. Other organs, including the liver, pancreas, and gallbladder, are also involved in the digestive system. 

The digestive tract is where the food you eat is turned into the nutrients your body needs to do the things you want to do. It starts with your mouth, teeth, and tongue.

Once you swallow, the food goes down your esophagus and into the stomach, where it is broken down into a pulp.

From your stomach, the pulpy mixture moves into the small intestine. Here, the digestive enzymes and fluid from the pancreas and bile from the liver help digest the food more so your body can use the nutrients in it.

The last parts of the GI tract are the large intestine, rectum, and anus. This is where the unusable bits of food you ate, along with bacteria, move out of your body as stool, also called a bowel movement.

When you chew and swallow, your food goes down the esophagus and into the stomach. The stomach makes acid that helps break down the food. Next, the food moves into the small intestine, where the body starts taking the nutrients and vitamins out of the food.

To extract these nutrients, the body needs the help of the pancreas. This organ, shaped like a small fish, is attached to the small intestine behind your stomach. It is crucial for proper digestion.

The pancreas makes fluid that mixes with the food. One part of that fluid is a product that neutralizes the acid from the stomach. It is called bicarbonate. The fluid also contains chemicals called pancreatic enzymes. These enzymes mix with the food to break them into small bits the body can absorb.

Pancreatic enzymes are very important for getting nutrients, calories, and vitamins into our bodies. They are the heart of proper digestion and absorption.

The pancreas also makes important hormones, including insulin. Insulin works in your bloodstream, not in your intestines. It helps move glucose (sugar) from the blood into the cells so they can turn food into energy.

One way to simplify this is to think of the pancreas as two separate organs. One is a digestive organ that makes pancreatic enzymes for the intestines. The other is a hormone organ that makes insulin for the body.

The healthy pancreas:

• Makes the body's natural antacid, called bicarbonate, to mix with food coming from the stomach into the intestines.
• Makes special chemicals called pancreatic enzymes to digest food as it moves from the stomach into the intestines.
• Squirts fluid into the intestines to help flush food along its path through the digestive tract.
• Makes important hormones, including insulin.

Problems With the Pancreas

For many people with CF, the pancreas doesn't produce enough insulin or the body doesn't let insulin do its job, leading to CF-related diabetes (CFRD). CFRD is not caused by diet, and there is nothing you can do to prevent it.

Most people with CF have sticky mucus that blocks ducts in the pancreas and prevents enzymes from reaching the small intestine to digest food. Undigested food in the intestines can cause pain, cramping, and gas. It can also cause either loose, greasy, floating stools or constipation and blockages.

Everyone with CF (including people who don't need enzyme supplements) has a pancreas that does not make enough bicarbonate to neutralize stomach acid. This can also contribute to pain, cramping, gas, and constipation.

Bloating and excessive gas can also be caused by small bowel overgrowth, gastric paresis, and gastroesophageal reflux disease:

• Small bowel bacterial overgrowth can be caused by repeated antibiotic therapy. This can kill good bacteria and cause bad bacteria to overgrow in the intestine and create gas, diarrhea, nausea, and bloating. Usually, the treatment is an antibiotic that helps tamp down bad bacteria to allow normal bacteria to regain control in the intestine.
• Gastric paresis is a condition in which the stomach empties slower than normal after eating. It can cause you to feel bloated and nauseous. High blood sugar can cause gastric paresis all by itself, so it helps to maintain a healthy blood sugar. Try to eat frequent, small meals throughout the day to help your stomach empty more efficiently.
• Gastroesophageal reflux disease (GERD) is caused when acid from your stomach travels backwards into the esophagus. This can be very serious if acid goes down into the lungs. See a doctor if you notice heartburn or other symptoms of GERD, or if you experience repeated vomiting, fever, or weight loss.

Read the Foundation's care guidelines on pancreatic enzyme replacement.

Among its many functions, the liver makes a fluid called bile that helps the body absorb fat. Bile travels through small tubes or ducts in the liver and is stored in the gallbladder, which empties the bile into the small intestine.

As the mixture of food, pancreatic fluid, bile, and enzymes moves along the small intestine, nutrients are absorbed through special cells in the walls of the small intestine.

Problems With the Gallbladder and Liver

In some people with CF, bile gets thick and flows very slowly. It can even get so thick that it forms stones in the gallbladder. These are called gallstones. They do not often cause symptoms or need treatment. Rarely, surgery is needed to remove the gallbladder. You can still have normal digestion if your gallbladder has been removed.

Less than 10% of people with CF experience CF-related liver problems. One type of liver disease is called cirrhosis. This is a condition where scar tissue replaces healthy tissue in the liver. According to CF Foundation clinical care guidelines, people with CF should get liver function tests annually. These blood tests watch for liver problems.

You can help reduce the chances of liver problems by:

• Getting vaccinated for hepatitis A and B
• Avoiding excessive alcohol use and IV drug use
• Eating a healthy diet

Below the small intestine comes the large intestine. A few nutrients are taken in by the large intestine. But its more important function is to keep the balance of fluid just right in the mass of what remains of the digested food.

The very end of the large intestine is called the rectum. This is where the mass of fully digested food and bacteria leaves your body in the form of stool, or bowel movement. Your care team will usually ask you about your bowel movements.

Myth Busters

• Can you treat constipation by not taking enzymes?
  
  No. Not taking your enzymes puts you at increased risk of having constipation or a bowel obstruction. If you are getting constipated or straining to move your bowels, keep taking or make sure you never miss taking your enzymes. Also, make sure you are drinking enough fluids every day. You may need a medication to draw water into the intestines to loosen stools or to thin mucus along the intestinal wall.
• If I have bowel movements every day, can I still be constipated?
  
  Yes. People with CF who are constipated almost always have bowel movements every day, often more than once a day. Symptoms of constipation include bloating, bloody stools, poor weight gain, poor appetite, “overflow” diarrhea, and rectal prolapse.
• If my doctor told me I have a working pancreas (pancreatic sufficient), do I have a normal GI tract?
  
  Not usually. You may still be prone to constipation, and you should still eat a high-fiber diet with plenty of fluids. You may also need medication to loosen stools or thin the mucus along the intestinal wall. Also, your pancreas is still sensitive to injury, so drinking excessive amounts of alcohol (binge drinking) can change you from someone with a working pancreas to someone whose pancreas doesn't work correctly.

The CF Foundation supports research focusing on the treatment of GI issues in CF.