What are the common causes of chronic abdominal pain in patients with Cystic Fibrosis (CF)?

From the Guidelines

Chronic abdominal pain in patients with Cystic Fibrosis (CF) is commonly caused by pancreatic insufficiency, which leads to fat and protein malabsorption, resulting in gastrointestinal symptoms such as loose, foul-smelling fatty stools and abdominal pain. The causes of chronic abdominal pain in CF patients can be multifactorial, including:

• Pancreatic insufficiency, which is present in over 80% of persons with CF, causing fat and protein malabsorption, as noted in the study by 1
• Gastrointestinal symptoms associated with fat malabsorption, including loose, foul-smelling fatty stools (steatorrhea) and abdominal pain, as reported in the study by 1
• Other potential causes of abdominal pain in CF patients, such as distal intestinal obstruction syndrome (DIOS), gastroesophageal reflux disease (GERD), small intestinal bacterial overgrowth (SIBO), constipation, CF-related liver disease, fibrosing colonopathy, and chronic pancreatitis, although these are not specifically mentioned in the provided study by 1 It is essential to consider the underlying pathophysiology of CF and its effects on the gastrointestinal system when evaluating and managing chronic abdominal pain in these patients, as highlighted by the study by 1, which emphasizes the importance of pancreatic insufficiency in CF patients. Management of chronic abdominal pain in CF patients requires a multidisciplinary approach, addressing both the underlying CF pathophysiology and specific pain generators, although the study by 1 does not provide specific guidance on management.

From the Research

Causes of Chronic Abdominal Pain in Patients with Cystic Fibrosis

• Chronic abdominal pain in patients with Cystic Fibrosis (CF) can be caused by various factors, including:
  • Distal intestinal obstruction syndrome (DIOS) 2, 3, 4
  • Constipation 2, 4
  • Gastroesophageal reflux (GER) 5
  • Abdominal symptoms such as lack of appetite, loss of taste, flatulence, and distention 6
• Patients with a history of meconium ileus, previous laparotomy, or pancreas insufficiency are at high risk of developing DIOS and chronic abdominal pain 3, 4, 6
• The use of laxative agents, stool softeners, and bowel preparation formulas can help manage DIOS and prevent chronic abdominal pain 2, 3, 4
• Abdominal symptoms in CF patients can be related to genotype, history, clinical and laboratory findings, and can have a significant impact on quality of life 6
• Other potential causes of chronic abdominal pain in CF patients include:
  • Rectal prolapse 6
  • Small bowel resection 6
  • Intermittent colonization with P. aeruginosa 6