INTRODUCTION
People with CF (pwCF) have frequent gastrointestinal (GI) symptoms,
including abdominal pain and irregular bowel
movements,1-3 which might contribute to significant
morbidity and mortality.4 The majority of pwCF suffer
from pancreatic insufficiency, leading to fat malabsorption,
malnutrition and abdominal discomfort when not appropriately
treated.5 Modulator therapy has been shown to improve
lung function and body weight in pwCF, however, the impact of these
modulators on GI symptoms is ambiguous and relatively
unknown.6-8
Since GI symptoms are embarrassing, they are challenging to assess and
often not reported to CF care team members. Therefore, there is little
systematic data on the mechanisms underlying the development of GI
symptoms in this population.1,9 Several
pathophysiological mechanisms have been proposed, including
malabsorption, altered GI-motility, psychological factors, diet and
microbial dysbiosis.4,10 The presence of GI symptoms
has been associated with neurophysiological and behavioral
symptoms,11 such as anxiety/depression and
health-related quality of life (HRQoL).12 It is
well-established that pwCF are at increased risk for developing symptoms
of anxiety/depression with negative consequences for CF disease
management, health outcomes, adherence to treatment and
HRQol.13-16 Biological factors, such as inflammation,
pain, and sleep disturbance have an effect on pwCF. This can be
explained by the gut-brain axis theory, describing the bidirectional
linkage between the nervous system and the GI tract. The gut-brain axis
links emotional and cognitive centers with the peripheral intestinal
functions.17 More studies are needed to examine the
potential links between GI symptoms, psychological symptoms, and HRQoL
in pwCF.18
Given that GI symptoms may be embarrassing to report, difficult to
assess, and often accompanied by substantial pain and disruptions of
daily activities,19-24 a standardized instrument to
measure these symptoms in pwCF, the GI Symptom Tracker, was developed by
Dr. Quittner in collaboration with AbbVie Inc. (2017). This
questionnaire consists of four subscales: Eating Challenges (4 items),
Stools (8 items), Adherence Challenges (5 items), and Abdominal Symptoms
(7 items). It has been developed to facilitate a standardized method of
assessing the frequency and impact of GI symptoms, to improve
communication between patient and provider, to open a dialogue about
strategies to reduce GI symptoms, improve medication adherence, and
maintain increased calorie intake, all with the goal of improving
patients’ health outcomes. It was developed and validated in 11 CF
centers in the US (n=179), demonstrating good reliability and
validity.1 The Dutch translation was recently
completed.20
The aim of this study was to investigate the relationship between GI
symptoms, as measured by the Dutch GI Symptom Tracker,
anxiety/depression and HRQoL in Dutch pwCF. We hypothesized that GI
symptoms would be associated with elevated levels of anxiety and
depression and worse HRQoL.