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Giardiasis aggravates malabsorption in cystic fibrosis

Despite high supplementation doses, persisting steatorrhea was observed in three pancreatic-insufficient, malnourished CF patients, aged 2 to 3 years. In all the patients, partial villous atrophy with Giardia intestinalis was found during histopathological examination. Anti-endomysial and antigliadin antibodies were negative. The genotypes of patients were as follows: F508/ F508 (n = 1), F508/N1303K (n = 1), F508/M (n = 1) (M = unknown CFTR mutation; 29 of the most common CFTR mutations were analyzed). All CF patients with villous atrophy were treated appropriately for underlying disease therapy (two courses of metronidazole at 1-month intervals). In addition, a gluten-free diet was introduced for a period of 1 year, which was the standard procedure in previous years in our department in patients with this degree of villous atrophy and untreatable malabsorption. In all patients, mucosal regeneration after at least 1 year of a gluten-containing diet was confirmed by intestinal biopsy. Patients remained symptom free during the rechallenge of a gluten-containing diet; anti-endomysial and anti-gliadin antibodies stayed negative, thus excluding celiac disease. In all subjects, fecal fat excretion and the coefficient of fat absorption (with enzymes—10.000 lipase kg 1 d ) were measured for 3 days at the beginning of the study and 1 year after the reintroduction of a gluten-containing diet. Fecal elastase-1 concentrations were measured at the beginning of the study and 1 year later to confirm that pancreatic insufficiency is a major cause of malabsorption in the studied group (2).