Malabsorption syndrome

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 absorbed.

Causes

For the causes of malabsorption syndrome see steatorrhea

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. There is diarrhea or steatorrhea, abdominal pain, weight loss and nutritional deficiencies. There may be evidence of anemia and malnutrition.

Diagnosis

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 various anemias, vit B12 etc. We may lastly resort to trial of various treatment regimens according to the most likely cause.

For more information see steatorrhea

Treatment

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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