Enzymes: Take Them Every Time You Eat
Most people with cystic fibrosis need to take pancreatic enzyme capsules with every meal and snack. The enzyme dosing guidelines are based on consensus rather than research. Doses vary greatly between individuals with CF. Avoid making dosing changes on your own. Always talk to your health care provider first.
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 medicine for this problem. These medications include:
Proton pump inhibitors
- Omeprazole (Prilosec®)
- Lansoprazole (Prevacid®)
- Esomeprazole (Nexium®)
- Ranitidine (Zantac®)
- Famotidine (Pepcid®)
- Nizatidine (Axid®)
- Old-fashioned, over-the-counter antacids, such as simethicone (Maalox® or Mylanta®), may be used along with — not instead of — proton pump inhibitors.
In addition to treating GERD, H2 blockers and proton pump inhibitors also can help reduce acid in the intestines to help the enzymes work better.
Other ways to treat GERD include:
- Not eating big meals just before lying down.
- Avoiding certain spicy foods, alcohol, caffeinated and carbonated beverages, and mints.
- Lifting the head of your bed with blocks to keep your body sloping down.
There also are some surgical procedures that tighten the muscle where the esophagus meets the stomach. Your physician may want to refer you to a stomach specialist (gastroenterologist) if GERD becomes an ongoing problem. You can use the American Gastroenterological Association's search tool to find a doctor who is in your area.
In addition to making the digestive juices, the pancreas normally squirts 1 to 2 quarts of fluid into the intestines every day. The production of this intestinal fluid is often limited in people with CF, even if they make a normal amount of 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 a hard time moving your bowels. Drinking plenty of fluids 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 of polyethylene glycol 3350 include MiraLAX®, GoLYTELY® and NuLYTELY®, but generics are also available.
Two CF conditions make it hard to move your bowels:
- Constipation is when thick stool sits in your large intestine. People with CF can have bowel movements every day and still have a lot of stool backed up in their large intestine. Extra fluids, more fiber in your diet and regular exercise can help prevent this backup. If you have constipation, talk to your CF doctor or CF dietitian about using a daily medicine like MiraLAX or GlycoLax® to keep fluid in your intestines.
- Distal Intestinal Obstruction Syndrome (DIOS) is a blockage or bowel obstruction, seen only in people with CF, in which thick stool sits right where the small intestine joins the large intestine. This condition can be severe enough to totally block your intestines, or it can be low-grade, when you have pain but aren't seriously ill.
Mild cases of DIOS may be treated at home with polyethylene glycol electrolyte solutions (MiraLAX or GoLYTELY). Severe DIOS needs to be treated in the hospital. You should call a doctor if you have:
- Severe pain that prevents you from functioning normally.
- Blood in stool or vomit.
- Fever (not explained by lung disease).
- Nausea so strong that you are unable to eat.
Treatments can include a nasogastric tube (NG), which goes through your nose and into your stomach to drain your intestine. Sometimes special enemas are used. Other treatments could include large-volume medication, such as polyethylene glycol electrolyte solutions (GoLYTELY, MiraLAX, or NuLYTELY), which can either be drunk or given through an NG tube.
These medicines draw 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.
You can learn more about these and other gastrointestinal medications at DailyMed, a service from the National Library of Medicine that provides information about drugs, including possible side effects. You can learn more about specific gastrointestinal medications by searching for the medication from the main DailyMed page. Please note that information about dosages apply to the general public and not necessarily to people with CF. For specific dosing information, talk to your CF care team.
“Good Bacteria” Treatments
Everyone's intestines have bacteria. 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 move up into the small intestine, where they can compete with our bodies for food. The bacteria can create gas and cause inflammation of the lining of the intestine, leading to pain, weight loss, or diarrhea.
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).
Antibiotics kill both “good” and “bad” bacteria, so you may also want to consider daily use of over-the-counter products called probiotics, which are live microorganisms. These are “good” bacteria that you can take in pill form or by eating foods such as yogurt or milk with L. acidophilus. There are supplements that offer a source of probiotics in combination with calories and protein. Food sources of probiotics can be more convenient and enjoyable than taking a probiotic in pill form. Some of these foods include:
- Kombucha — not all brands are equal so it is important to check the label for probiotic content.
- Sour pickles, salt cured — not vinegar; found in the refrigerated section.
Discuss with your CF dietitian and your CF doctor whether eating these foods is safe for you.
For more information on probiotics, visit the National Center for Complementary and Integrative Health.
What Else You Can Do
Things you can do to keep your GI tract as healthy 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. It is 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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Information contained on this site does not cover all possible uses, actions, precautions, side effects, or interactions. This site is not intended as a substitute for treatment advice from a medical professional. Consult your doctor before making any changes to your treatment.
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