Malabsorption refers to a clinical condition in which
a number of nutrients aren?t normally absorbed; almost always lipids fail
to be absorbed. At times absorption of single nutrients may be selectively
For the causes of malabsorption syndrome
Clinical picture (symptoms and signs)
Clinical suspiscion of malabsorption syndrome: Most
present with weight loss and diarrhoea. Some with vitamin deficiencies,
bleeding disorders, osteoporosis. Risk factors include GIT surgery and digestive
tract abnormalities plus traveling to endemic areas.
Symptoms are those of small bowel disease with malabsorption.
diarrhea or steatorrhea, abdominal pain, weight loss and nutritional
deficiencies. There may be evidence of
anemia and malnutrition.
Prove the existence of steatorrhea.
Steatorrhea is the passage of fat > 6 g/24 hr stools.
The 1st step after proving steatorhea is to differentiate between absorptive
abnormality and digestive abnormality. This is done by the D-xylose test.
D-xylose is a sugar that does not need to be digested to be absorbed. Hence
if urinary excretion is low this infers an absorptive abnormality which
may be bacterial overgrowth (breath test) or diffuse lesion (jujenal biopsy).
If xylose test is normal then it is a digestive disease: we start
by requesting a bentiromide test for pancreatic insuffiency. If not then
the next step in digestion is bile acid so we request the bile acid breath
test. If all are negative then we check for selective disorders by CBC showing
anemias, vit B12 etc. We may lastly resort to trial of various treatment
regimens according to the most likely cause.
For more information
Malabsorption is a common presentation for a variety of diseases. Treatment
of malabsorption is essentially the treatment of the causing disease.
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