24/02/2021 / Digestive Disease & Gastroenterology
Malabsorption is an intestinal disorder in which nutrients are not completely absorbed by the body. The disorder may occur for a single nutrient or multiple nutrients at the same time. When the gastrointestinal tract functions normally, it digests and absorbs all the nutrients present in the diet very effectively. In case of any impairment, at any step of the process of digestion and absorption, malabsorption of nutrients can occur. If the abnormal digestion occurs at a single step in the whole process, then malabsorption of a selective nutritional component may occur. But when the disease is extensive in nature and affects a large part of the intestinal tract then generalized malabsorption of several nutrients may occur. Malabsorption results in poor health, pain in the abdomen, nausea, anorexia, and various kinds of anemia. Some common types of malabsorption diseases are steatorrhoea, lactose intolerance, fructose malabsorption, and celiac disease.
The signs and symptoms of malabsorption are manifested in a wide range of ways and differ for the type of nutrient which is not getting absorbed. Some common signs and symptoms that are usually visible in all kinds of malabsorption are:
Diarrhea with frequent, watery, and bulky stool. This happens because of the impairment in carbohydrate, water, and electrolyte absorption. Sometimes, unabsorbed fatty acids result in flatulence, abdominal cramps, and bloating.
Weight loss is also observed even if the patient is taking a sufficient diet.
Edema or swelling in various body parts is seen as a result of protein loss.
Anemia is common in malabsorption because of the deficiency of folic acid, vitamin B 12, and iron which is reflected by weakness and fatigue.
Muscle cramps may occur from decreased absorption of calcium and vitamin D which can even lead to serious deficiency disorders such as osteoporosis and osteomalacia.
A tendency to bleed profusely as a result of vitamin K deficiency.
Many factors may cause the malabsorption of nutrients from the gastrointestinal tract. Some of them are listed below:
One of the causes of malabsorption can be structural defects of some parts of the gastrointestinal tract such as strictures (narrowing of the passage), fistula (an abnormal connection between body parts), and blind loops.
Malabsorption may occur in various infectious diseases such as intestinal tuberculosis, HIV, parasitic infection (due to tapeworm, hookworm, or roundworm), tropical sprue, and Whipple's disease.
The abnormality in the mucous layer of the intestinal wall containing the digestive glands is called mucosal abnormality. The malabsorption diseases associated with mucosal abnormality include celiac disease, lactose intolerance, and fructose malabsorption.
Many surgical procedures such as bariatric surgery (surgery for weight loss), vagotomy (surgery to reduce gastric secretion), and gastrectomy (removal of all or a part of the stomach) can cause malabsorption.
The failure of digestion due to bacterial overgrowth, Crohn’s disease, obstructive jaundice, cystic fibrosis, chronic pancreatitis, etc. can also cause malabsorption of nutrients from the digestive tract.
Deficiency of enzymes:
Deficiency of certain enzymes such as lactase, intestinal disaccharidase, enteropeptidase, etc. may cause malabsorption.
Many other systemic diseases that affect the GI tract can cause malabsorption. These diseases include Addison’s disease, fiber deficiency, diabetes mellitus, hyperthyroidism, and hypothyroidism, etc.
The diagnosis of malabsorption is not easy as there is no specific, single test for the disorder. Investigation of malabsorption is done by evaluating the signs and symptoms. Malabsorption can be produced by a wide range of conditions; therefore, it is essential to consider each one of them. Some of the common tests used for detecting malabsorption are:
Routine blood test helps in detecting anemia, protein deficiency, and electrolyte imbalance. Low triglyceride or cholesterol level in blood shows malabsorption of fat. Likewise, Low calcium and phosphate levels may give a clue for low vitamin D and risk of osteomalacia. Several serological studies such as the test for celiac disease are done to detect the sensitivity of the GI tract for gluten and thereby knowing the cause of malabsorption.
Microscopic study of stool samples is useful in diseases like diarrhea. This helps in detecting the presence of pathogens, protozoa, parasites, and other infective agents. The stool test of the malabsorption patient is also done to detect the presence of fat in stool and can help in diagnosing steatorrhoea.
A breath test is recommended to detect the presence of hydrogen gas in patients who may have lactose intolerance. If the lactose is not absorbed sufficiently, hydrogen gas is produced in the intestine.
Sometimes doctors prescribe CT scans of the abdomen to check the structure and function of the organs. The structural abnormality can be a cause of malabsorption.
The treatment of malabsorption diseases mainly includes managing the underlying causes. Replacement of certain nutrients, fluids, and maintaining the electrolyte balance is necessary in some cases. Pancreatic insufficiency is treated by oral ingestion of pancreatic enzyme supplements. Some conditions require dietary modifications; for example avoiding milk and milk products in lactose intolerance, avoiding fruits in fructose malabsorption, and a gluten-free diet in celiac disease. Antibiotic therapy is also prescribed to reduce bacterial growth in the intestine and treat malabsorption occurring from microbial overgrowth.
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