Maldigestion, dysbiosis, inflammation and dysmotility: a toxic tetrad in the CF gut.

Gastrointestinal symptoms are common in CF, present in at least 65%, and possibly as high as 98% of people with CF (PwCF) and up to 20% reporting these symptoms to be moderate to severe. Chronic GI symptoms including flatulence, bloating, nausea, fullness and abdominal distension experienced by PwCF are likely more complex than a single structural etiology, and may be attributable to or amplified by a complex interaction of biopsychosocial factors. Here we explore the "toxic tetrad" of known abnormalities throughout the CF gut: maldigestion, dysbiosis, inflammation and dysmotility, all of which are inter-related and ultimately contribute to the final end result of chronic GI symptoms for PwCF. Furthermore, we consider diagnostic and therapeutic modalities for dysmotility and dysbiosis in the general population and consider potential applicability and limitations in PwCF.