Review Article

Is Gastroparesis Found More Frequently in Patients with Cystic Fibrosis? A Systematic Review

Table 2

Case-control (higher-quality) studies evaluating gastric emptying in cystic fibrosis.

AuthorSample   (CF/control)Cystic fibrosis Controls matchingFood used to deliver markerPERT before testingFollow-up timeNOS
Rater 1/Rater 2
Conclusion
DiagnosisDMMean BMIPancreatic insufficiencyPulmonary functionMedications

Capsule methods
Hedsund et al. [14]26 (10/16)All had severe classes I–III mutations (7 were ΔF508 homozygote)0 (0%)22All cases (confirmed by fecal elastase)NAGI medication, antibiotics, and probiotics held >72 hUnmatchedMTS-1 Capsule fastingNAHeld7 h max3/6No difference (CF slower, but )
Gelfond et al. [15]20 (10/10)Sweat Cl > 60 mmol/L or 2
CF mutations (6 were ΔF508 homozygote)
0 (0%)22.9All cases (confirmed by fecal elastase, coefficient of fat absorption or serum trypsinogen)FEV1 > 25% predictedAntiacids and antibiotics held >1 week Age, sex, BMISmartpill with low fat meal barSolidHalf their usual dose 72 h max5/6No difference

C-Octanoic breath test
Symonds et al. [9]22 (10/12)Sweat Cl > 80 mmol/L or “genotype determination”NANAAll cases (confirmed by coefficient of fat absorption or steatorrhea + microscopic stool fat)NANot taking any GI motility medicationUnmatchedPancake, toast, orange juice, and milkSolidUsual dose 8 h3/6No difference

Scintigraphy with technetium
Carney et al. [21]16 (5/11)NA0 (0%)NAAll cases (confirmed by steatorrhea + high 3-day fecal fat)FEV1 > 50% predictedNAUnmatchedSoup and olive oilLiquidHeld 14 h prior2 h4/7GE of fat is faster in CF
Collins et al. [22]36 (19/17)NA2 (10.5%)NAAll cases (confirmed by high 3-day fecal fat)NANot taking any GI motility medication >4 daysAge, sexPancakeSolidUsual dose2 h7/7GE is faster in CF
Couturier et al. [24]101 (48/53)NANANANASevere pulmonary disease pre transplantNAUnmatchedEgg, bread meal, and waterSolidNA2/3 of stomach emptied5/4GE is slower in CF ( = 0.001)
Kuo et al. [28]11 (5/6)NA0 (0%)
1 with glucose intolerance
20.0 All cases (NA)NANAUnmatchedSmashed potatoesSolidCrossover
Arm 1: no enzymes.
Arm 2: twice the usual dose
3 h4/6GE is faster in CF ( < 0.001). But PERT slowed GE substantially in CF to a rate comparable to healthy subjects
Mendez et al. [29]88 (10/78)NANA20NAPostlung transplantNABoth CF and controls had lung transplantEggSolidNA1.5 h4/4Both groups had delayed GE, but CF > controls (44% and 29%, resp.)
Rovner et al. [4]28 (16/12)NA0 (0%)19.6All cases (confirmed by a fecal elastase)FEV1 > 50% predicted NAUnmatchedChocolate shakeLiquidStandard dose (80,000 lipase U)6 h6/9No difference

78 controls had end-stage pulmonary disease: 36, COPD; 32, idiopathic pulmonary fibrosis; 7, alpha-1-antitrypsin deficiency; and 3, scleroderma.
Four subjects with CF had history of distal DIOS and 1 had history of bacterial overgrowth not being treated at the time of study.
GE = gastric emptying.
CF: cystic fibrosis, NOS: Newcastle-Ottawa score, NA: data not available, DM: diabetes mellitus, and DIOS: distal intestinal obstructive syndrome.