Supplementation of ursodeoxycholic acid improves fat digestion and absorption in cystic fibrosis patients with mild liver involvement.
Level 3 - non-randomized controlled study
Prospective single-arm interventional withdrawal study with within-subject comparisons
PubMed 26882172 · doi:10.1097/MEG.0000000000000593
What was done
The authors assessed fat digestion and absorption in 23 cystic fibrosis patients with mild liver involvement using a 13C-mixed triglyceride breath test. Testing occurred while patients were taking ursodeoxycholic acid (UDCA) (evaluated without pancreatic enzymes, with standard enzyme doses, and with increased enzyme doses in 16 patients with abnormal initial tests) and again after 1 month of UDCA withdrawal. Cumulative percentage dose recovery (CPDR) served as the measure of lipid absorption.
What was found
Adding standard pancreatic enzymes improved median CPDR from 0% (IQR 0–0) to 4.6% (IQR 0.4–6.0; P < 0.00046). Increasing the enzyme dose in 16 patients with abnormal breath test results further increased CPDR to 8.6% (IQR 5.6–12.7; P < 0.000027). Subsequent withdrawal of UDCA for 1 month resulted in a significant reduction of CPDR to 2.9% (IQR 0.7–5.8; P < 0.000031).
Why it matters
These findings suggest that UDCA improves lipid assimilation alongside pancreatic enzyme replacement therapy in cystic fibrosis patients with liver involvement, highlighting the role of bile acid availability in fat digestion.
Limits
The study had a small sample size (n = 23, with a subgroup of 16) and used an unblinded, non-randomized withdrawal design without a parallel control group. Long-term nutritional endpoints (such as weight gain or growth) were not evaluated, only surrogate breath test kinetics.
Cited by
- contradicts TUDCA is mostly water-soluble rather than fat-soluble, preventing it from aiding fat digestion.