Cystic fibrosis (CF) is a genetic disorder affecting approximately 30,000 people in the United States.
1 This disease manifests itself in multiorgan systems, primarily targeting the lungs and gastrointestinal system. Chronic constipation is a common issue for many patients, and 5.9% of patients older than 18 years have distal intestinal obstructive syndrome (DIOS).
1 The incidence of DIOS is greater in the adult population (35.5/1,000 patient years) than in the pediatric population (6.2/1,000 patient years) with CF.
2 Constipation in patients with CF is defined as (1) abdominal pain and/or distention, (2) reduced frequency of bowel movements, and (3) symptom relief with laxatives.
3 In contrast, DIOS is defined as abdominal distention and pain with a fecal mass at the ileocecal junction.
2 There are several proposed mechanisms for DIOS. One includes pancreatic insufficiency with inadequate doses of pancreatic enzymes leading to malabsorption of fat, which causes slowed intestinal transit and increased viscosity in the intestines. However, DIOS is also seen in pancreatic-sufficient patients, indicating that this may not be the sole contributor.
4 Dysmotility has been suggested to add to this disease process, along with abnormal mucins and water balance seen in the gastrointestinal tract and lungs of these patients.
5,6 Similarly, constipation in patients with CF has analogous proposed mechanisms,
7 which suggests a role for osteopathic manipulative treatment (OMT) in the management of bowel dysfunction in these patients because OMT has been suggested to improve intestinal motility.
8-10 The role of OMT as a preventive and therapeutic modality for patients with CF has yet to be determined.