In contrast to the airways, the defects in colonic function in cystic fibrosis (CF) patients are closely related to the defect in CFTR. The gastrointestinal phenotype of CF transgenic mice closely resembles the phenotype in CF patients, which clearly indicates the crucial role of CFTR in colonic Cl⁻ secretion and the absence of an effective compensation.

In the colon, stimulation of CFTR Cl⁻ channels involves cAMP- or cGMPdependent phosphorylation. Exocytosis is not involved. Activation of CFTR leads to coactivation of basolateral K_VLQT₁-type K⁺ channels and inhibition of luminal Na⁺ channels (ENaC). In contrast to cultured cells, Ca²⁺ does not activate luminal Cl⁻ channels in intact enterocytes. It activates basolateral SK4-type K⁺ channels and luminal K⁺ channels, which provide additional driving force for Cl⁻ exit. The magnitude of Cl⁻ secretion, however, completely depends on the presence of at least a residual CFTR function in the luminal membrane.

These findings have been clearly demonstrated by Ussing chamber experiments in colon epithelium biopsies of CF and normal individuals: Colonic Cl⁻ secretion in CF patients is variable and reflects the genotype; a complete defect of CFTR is paralleled by the absence of Cl⁻ secretion and unmasks Ca²⁺-regulated K⁺ channels in the luminal membrane; overabsorption of Na⁺ in CF reflects the absence of ENaC inhibition by CFTR; and the functional status of CF colon can be mimicked by the complete suppression of cAMP stimulation in enterocytes of healthy individuals.