In Reply.—The case described by Townes and Kopelman is of interest in that it suggests that isolated exocrine pancreatic deficiency may be a cause of the meconium plug syndrome (MPS). On the basis of this observation, the authors suggest that the MPS seen in our patients with cystic fibrosis (CF) was likewise probably due to pancreatic deficiency. Although I agree with their speculation that the MPS and meconium ileus (MI) "may be different manifestations of the same pathologic process," there is conflicting, albeit fragmentary, data suggesting that exocrine pancreatic deficiency may not be the sole cause of meconium obstruction in CF. There is little documentation of normal exocrine pancreatic function in infants with CF and MI, but there are rare anecdotal references to such cases.1 Several investigators have suggested that MI may be the result of abnormal protein and mucoprotein secretions by the intestinal goblet cells and not
ROSENSTEIN BJ. Meconium Plug Syndrome, Cystic Fibrosis, and Exocrine Pancreatic Deficiency-Reply. Am J Dis Child. 1978;132(10):1043–1044. doi:10.1001/archpedi.1978.02120350111027
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