Gastrointestinal pathophysiology and nutrition in cystic fibrosis

Expert Rev Gastroenterol Hepatol. 2018 Sep;12(9):853-862. doi: 10.1080/17474124.2018.1502663. Epub 2018 Aug 3.


Cystic fibrosis (CF) is a severe, progressive, multisystemic disease that is caused by mutations in the cystic fibrosis transmembrane conductance regulator gene. Optimizing nutrition is critical, as higher growth parameters are associated with better pulmonary function and outcomes, but unfortunately patients with this disease are prone to malnutrition, growth failure, and vitamin deficiencies. The purpose of this review is to provide a timely highlight of the physiologic processes and outcome data to support today's management strategies, as well as review these principles themselves. Areas covered: This review covers the background of the importance of vigilant attention to nutrition and growth in these patients, the underlying physiology leading to an abnormal gastrointestinal tract and its role in CF malnutrition, and current evaluation and management strategies to address nutrition in CF. Analysis of up-to-date relevant literature was performed using PubMed. Expert commentary: Advances in research and clinical developments over the years have improved knowledge of this disease as well as patient outcomes. Of particular importance is optimizing nutrition especially in the early stages of life, as well as accounting for the markedly abnormal CF intestinal milieu when addressing the gastrointestinal and nutritional needs of these patients.

Keywords: Cystic fibrosis transmembrane conductance regulator (CFTR); Pancreatic enzyme replacement therapy (PERT); cystic fibrosis; enteral nutrition; failure to thrive; growth failure; malabsorption; nutrition; pancreatic insufficiency; vitamin deficiency.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adolescent Development
  • Adolescent Nutritional Physiological Phenomena
  • Child
  • Child Development
  • Child Nutritional Physiological Phenomena*
  • Child, Preschool
  • Cystic Fibrosis / complications*
  • Cystic Fibrosis / genetics
  • Cystic Fibrosis / physiopathology
  • Cystic Fibrosis / therapy
  • Cystic Fibrosis Transmembrane Conductance Regulator / genetics
  • Gastrointestinal Diseases / etiology*
  • Gastrointestinal Diseases / genetics
  • Gastrointestinal Diseases / physiopathology
  • Gastrointestinal Diseases / therapy
  • Gastrointestinal Tract / physiopathology*
  • Humans
  • Infant
  • Infant Nutritional Physiological Phenomena
  • Infant, Newborn
  • Malnutrition / etiology*
  • Malnutrition / genetics
  • Malnutrition / physiopathology
  • Malnutrition / therapy
  • Mutation
  • Nutritional Status*
  • Nutritional Support


  • CFTR protein, human
  • Cystic Fibrosis Transmembrane Conductance Regulator