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Diet- large intestine

Question
As a child with CF grows and the quality/quantity of the food is stable (nothing has changed) is it possible that it may not need as much Creon as it did when it was younger? I observe that the defecations stress the child.
If we assume that the Creon is too much, how do I deal with the cacations? Should I give a meal without Creon? Since the hard feces are in front how can the softer feces come out? Is there a way to help the child and in what way?
Answer
Dear friend,
The pancreatic enzymes are administered orally before and during meals as a substitution therapy due to the malfunction of pancreas in 85% of CF patients for the digestion of the food and the stable and normal growth by reducing or minimizing the symptoms from the gastrointestinal system.
This is achieved when the patients have 1-2 defecations per day with normal volume and when the patients gain weight. The pancreatic enzymes contain lipase, amylase and protease.
The substitution therapy for the pancreatic function with pancreatic enzymes is personalized and depends on the following factors:
a) the constitution and the quantity of food being consumed
b) the pH of the stomach and the duodenum intestine
c) the anatomic and physiologic differences between each person (e.g. the number of food pellets and the rate of propulsion from the stomach to the duodenum in relation to each meal).
The pancreatic enzymes should be administered before the meal. If there is a severe case of malabsorption (fatty feces of great volume, no weight gain), then the quantity of enzymes must be increased and they should be distributed in a right way to cover every meal.
The dosage of pancreatic enzymes can be defined as units of lipase per gramm of intaken fat, or per kilogram of body weight per meal and is modified according to the symptoms of malabsorption.
Your child probably needs a better distribution of the enzymes, or it has a constipation issue, which is a frequent symptom that must be addressed. Most probably, both the above coexist.
No meal is given without administering enzymes, nor should enzymes be administered without a meal and without the consultation of your CF center, be it the dietician or the doctor.
I think you should discuss in detail your problems with the pediatrician and the dietician of your CF center at your next visit. Till then it is advisable to contact your dietician on the phone.
The malabsorption issue must be investigated and differentiated from any other gastrointestinal issues that may coexist.
Yours friendly,
Dr. Stavros Doudounakis
10.07.2012