Gastric Emptying and Lingual Lipase Activity in Cystic Fibrosis

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Abstract
Summary: To identify gastric factors likely to contribute to fat maldigestion and malabsorption in cystic fibrosis (CF), gastric emptying time, secretion rate, and preduodenal lipolytic activity were studied. Gastric emptying of a liquid test meal and gastric acid secretion were determined in five CF teenagers with pancreatic insufficiency and in five healthy controls. During the first hr, the rate of gastric emptying exhibited a linear pattern in both CF patients and controls. Neither the emptying time nor the gastric secretion rate was different. Lingual lipase activity was measured in eight other CF patients with pancreatic insufficiency and in eight controls. Lipase activity was higher (P ≤0.05) in CF patients than in controls with values (± ± S.E.) of 34.48 ± 11.59 and 12.65 ± 5.60 μmole butyric acid min-1 ml-1, respectively. No correlation with age or body surface was observed. Intragastric lipolysis of a butterfat triglyceride test meal was fast in both groups, but more extensive (P ≤0.05) in CF patients than in controls. The data show that in CF with pancreatic insufficiency, gastric factors contributing to the first step of fat digestion are preserved. In fact, lingual lipase activity was found to be increased, and a more complete intragastric lipolysis was documented. Speculation: In view of the normal gastric emptying time, high lingual lipase activity, and significant degree of hydrolysis of a fatty meal taking place in the stomach of CF patients, the use of acid-resistant lingual lipase supplements could be considered as a new approach to the treatment of the lipolytic phase defect associated with pancreatic insufficiency in cystic fibrosis.