Category Archives: Malabsorption Syndromes
Skin Rashes in Infants
Skin rashes of different types may occur in infants and children due to various reasons, but usually they are not very serious.
- Rashes in infants may be caused by viral, fungal and bacterial infections, or due to irritation of the skin and allergies.
- Different types of rashes include itchy red rashes; fluid filled cysts; yellow scaly rashes; milky pimples or bumps on the skin.
- Many rashes disappear without any treatment. Some may become better with the application of moisturizers and gentle cleansing lotions.
- Application of anti fungal and anti bacterial ointments and antibiotic therapy may be necessary in some cases. Anti-itch medication can relieve severe itching.
Diaper rash:
It is one of the most common rashes in infants. This bright red rash appearing in the diaper area is due to the irritation caused to the tender skin by the almost constant contact with excretory materials such as urine and stools. The areas of the skin which are in touch with the diaper are especially affected. It is also referred to as diaper dermatitis.
Bacterial and fungal infections can also cause diaper rash. A typical fungal infection caused by Candida gives rashes, bright red in color, along the skin creases. Tiny red spots also may be present. Diaper rash due to bacterial infections are rarer. Babies who are exclusively fed on breast milk are found to have lower incidence of diaper rash as their stools may not have as many irritating substances and enzymes as the stools of infants who take formula milk. Using highly absorbent diapers, with moisture-locking gel filling, may reduce rashes by keeping the infant dry. Frequent diaper changes, and avoiding plastic pants which keep moisture in and restrict air circulation, also may help. Most children who have diaper rash are not usually bothered by the condition.
The usual treatment for diaper dermatitis is frequent change of diapers, and allowing for air circulation in the diaper area. Mild soaps should be used to clean the affected area. Most cases of diaper rash clear up without any further treatment. Petroleum jelly, ointments containing zinc, vitamin A & D ointment, or moisturizers, can act as a barrier to moisture and may prevent rashes. If Candida infection is present, the doctor may prescribe an antifungal cream to clear up the rash. Antibiotic creams may be required to treat rashes caused due to bacterial infections.
Eczema:
It is a dry rash causing the skin in the affected area to appear red and scaly. It usually appears as patches at the joints of the hands and legs. Cold weather and dry climate worsens the condition. The rashes due to eczema, otherwise referred to as atopic dermatitis, may come and go without any apparent reason. Its cause is also not known. Allergy is thought to be the trigger for eczema and it is considered to be similar in origin to asthma. It usually runs in families too, much like asthma does.
Many children who have eczema in infancy and childhood may outgrow the condition eventually. However, in some cases, the episodes continue lifelong. There is no cure for eczema, but the condition can be treated with moisturizers, corticosteroid creams and the use of gentle cleansing agents. Anti-itch medication, and humidified air, may give some relief to the itching and scaling skin. Identifying triggers such as dust mites and other allergens, and avoiding them, may reduce the frequency and severity of attacks.
Cradle cap:
It is a crusty and scaling yellow and red rash often occurring on the infant’s scalp. Occasionally it may appear in some skin folds too. The cause of this condition, also referred to as seborrheic dermatitis, is not known. Infants with cradle cap do not seem to be bothered by the condition, and it usually disappears by the time the infant is six months old. Applying mineral oil to the scalp, and using shampoos regularly to wash the head, may help reduce the crusty scales. Those crusts tangled in the hair can be gently removed with a comb. A severe cradle cap which persists, and does not respond to the above measures, may require treatment with corticosteroid creams or the application of shampoos containing selenium.
Tinea:
It is a fungal infection affecting the skin in different parts of the body. While tinea capitis affects the skin of the scalp, tinea corporis, commonly called ringworm, appears on the body. When tinea is diagnosed in infants and children, it is treated in the same way this fungal infection is treated in adults. In some children, the condition may be worsened by an inflammatory response to the infection causing the formation of a scalp mass known as kerion. This complication requires further specialized treatment.
Molluscum contagiosum:
It is a rash caused by a virus. It appears as a cluster of pearly pimples or flesh-colored bumps, and disappears after a while without any specific treatment.
Milia:
They appear as small pearly white cysts on the infant’s face in the early days of life. It is caused by the first oil secretions from the newborn’s skin glands. They disappear within days, without any treatment.
Common Viral Infections:
They are common causes of rashes appearing suddenly in infants, as well as, children. Roseola, rubella, and the infection erythema infectiosum, which is known as the fifth disease, are viral infections causing characteristic rashes. They are not serious, and do not cause much discomfort to the children. Other common rash-forming viral diseases such as chicken pox and measles are increasingly becoming rare as vaccinations against them are being widely used.
Watch This Video About Viral Skin Rashes in Babies :
Share and Enjoy
Bacterial Overgrowth Syndrome
Bacterial overgrowth syndrome is caused by the slowing down of intestinal movements facilitating the excess growth of normal bacteria inhabiting the intestines, resulting in malabsorption and diarrhea.
- Diarrhea, weight loss and deficiency diseases are the usual symptoms, though it may remain asymptomatic in some people
- The normal movement of the intestinal contents may become slow or completely stop due to certain conditions.
- Typical symptoms displayed after undergoing certain surgeries lead to diagnosis.
- Drug therapy with antibiotics helps recover from this condition.
The peristaltic movements of the intestines help move their contents at a steady pace, effectively keeping the bacterial population under control. When the movements of the intestines slow down or stop completely, the contents remain in the intestines for a longer period or they get accumulated in places, encouraging the excessive proliferation of bacteria. Certain surgeries involving the intestines or the stomach may temporarily stop the peristaltic movements. Amyloidosis, systemic sclerosis, and diabetes are some of the common causes for the slow movement of intestine and excess growth of bacteria.
The increased population of bacteria uses up the nutrients such as carbohydrates and vitamins derived from food. Not only that, it breaks down the bile salts produced by the liver, making the digestion and absorption of fats difficult, resulting in diarrhea and nutritional deficiencies.
Symptoms such as diarrhea and deficiency diseases are usually caused by this condition but in some cases, these symptoms may be absent or weight loss may be the only obvious symptom.
Diagnosis and Treatment of Bacterial Overgrowth Syndrome
The diagnosis is based on the symptoms which appear after abdominal surgeries involving the stomach and the intestines. Inserting a plastic tube into small intestine through the nose, a sample of the intestinal fluid is drawn and tested to confirm the diagnosis. Sometimes, another test called C-xylose breath test is conducted. A solution of slightly radioactive carbon-14 in combination with xylose sugar is swallowed, and later the breath is analyzed for free carbon-14 to determine the amount of xylose sugar used up by the bacterial populations.
Oral antibiotic therapy for a period of ten days to two weeks is usually sufficient to reduce the bacterial population. Nutritional supplements may be prescribed to compensate for the deficiencies which may have been caused by the condition.
Share and Enjoy
Short Bowel Syndrome
Short bowel syndrome Or sometimes known as short gut syndrome develops when a considerable length of the small intestine is surgically removed, resulting in diarrhea and malabsorption.
- Significant shortening of the small intestine by the surgical removal of a large portion from it results in this condition.
- Chronic diarrhea is the most common symptom of short bowel syndrome.
- Fluids and nutrients are administered intravenously following the surgery, but in some cases, it may have to be continued throughout life.
- Drug treatment with cholestyramine and loperamide may provide relief from diarrhea.
Food is partly digested in the stomach but the small intestine is where the major part of the digestive and absorptive processes takes place. When a part of the small intestine is surgically removed, it affects the digestion of food and absorption of nutrients into the blood by varying degrees depending on the location and length of the missing part. When a small portion is removed, the remaining portion may take over its function. For example; the last part of the small intestine called ileum often compensates for the loss of the middle part called jejunum. But when 3 feet or more of ileum is lost, the rest of the intestine is unable to cope. During the period before the remaining intestine adapts, or when it is unable to adapt, absorption of various nutrients such as proteins, fats and vitamins become severely affected. The intestine may be unable to absorb the bile secretion necessary for digestion too.
Inflammatory bowel diseases such as Crohn’s disease, a block in the mesenteric artery supplying to most of the intestine called mesenteric infarction, and blockage caused by volvulus or twisting of an intestinal loop, are some of the usual reasons for the large scale removal of the small intestine. Intestinal cancers as well as radiation enteritis resulting from the damage caused to the intestine by the exposure to radiation during the treatment of cancers, and congenital defects, are a few other reasons.
The first symptom to appear after the surgery is diarrhea due to malabsorption. Subsequently, malnutrition and deficiency diseases develop.
Treatment Of Short Gut Syndrome
Total parenteral nutrition or TPN is administered immediately following the surgery, to provide the patient with complete nutritional support. Carbohydrates, proteins and fats necessary for the body, along with all essential minerals and vitamins, are included in the TPN. Gradually, as the diarrhea subsides, the patient is weaned of parenteral nutrition and oral feeding of fluids is started. Depending on the patient’s tolerance, further additions are made facilitating gradual adjustment to normal diet.
The normal length of the small intestine ranges from around 12 feet to 21 feet. When more than three fourths of the small intestine has been removed, or when large amounts of fluid is being lost through continuing diarrhea, life-long dependence on TPN may be unavoidable. If oral feeding is tolerated, a diet containing less amount carbohydrate, but more of proteins and fats, is advised. Avoiding large meals, and taking several smaller ones frequently, may help in better absorption.
Loperamide is an effective antidiarrheal drug that can be taken an hour prior to meals, to prevent diarrhea which would otherwise occur after meals. If diarrhea is caused by the inability to absorb bile and utilize it for digestion, taking cholestyramine along with meals may help reduce it. Vitamin and mineral supplements have to be taken life-long to prevent deficiencies of magnesium, calcium and vitamins. Vitamin B12 injections may be required every month.
When a patient can neither adapt to the short bowel, nor tolerate TPN for extended periods, transplantation of the small intestine is an option.
Share and Enjoy
Intestinal Lymphangiectasia (Idiopathic Hypoproteinemia)
Intestinal lymphangiectasia is a malabsorptive disorder caused by abnormalities such as enlargement and obstruction of the lymph vessels which line the wall of the small intestine. It is also referred to as idiopathic hypoproteinemia.
- Abnormalities in the lymphatic vessels cause this condition.
- The most common symptom is chronic diarrhea.
- Biopsy of a part of the intestine showing enlarged lymphatic vessels helps in diagnosing the condition.
- Treatment involves resolving the cause of the condition, as well as managing the symptoms by following a low-fat diet high in proteins, in addition to taking vitamin and mineral supplements
After the food is digested, the small intestine absorbs the nutrients. Some of the nutrients are assimilated directly into the blood. The function of the lymph vessels in the lining of the small intestine is to absorb the fats and carry them to the blood vessels. But when there are abnormalities in the lymph vessels, it affects the assimilation of proteins and fats into the blood. Congenital abnormalities in the lymph vessels are the most common cause which results in their enlargement. Pancreatitis, in which pancreas is inflamed, and constrictive pericarditis, in which pericardium enclosing the heart becomes stiff, are two other conditions resulting in the enlargement of lymph vessels. The enlargement of vessels results in leakage of the lymphatic fluid back into the small intestine inhibiting the absorption of proteins and fats into the blood.
Symptoms and Diagnosis
Nausea and vomiting, pain in the abdomen, and chronic diarrhea with fatty stools are the most common symptoms of intestinal lymphangiectasia. Blockage of lymph vessels in other parts of the body may cause edema. Tissue swelling may occur due to the lower than normal protein levels in the blood caused by this condition. Lower levels of cholesterol and reduction in the lymphocyte count are other symptoms resulting from intestinal lymphangiectasia.
Intestinal lymphangiectasia is diagnosed if the biopsy of a portion of the small intestine shows enlarged lymphatic vessels. The quantity of a protein called alpha1-antitrypsin in the stool is measured to assess how much protein is lost back into the intestines.
Treatment
When the cause of the intestinal lymphangiectasia is determined, the cause is treated appropriately. A low-fat diet rich in proteins is followed to get relief from symptoms. There are some fats called medium-chain triglycerides which can be absorbed by the blood directly without the aid of the lymphatic system. The diet can be supplemented by medium chain triglycerides, and also other minerals and vitamins to prevent deficiency diseases.
Intestinal Lymphangiectasia (Idiopathic Hypoproteinemia) Video Summary
Share and Enjoy
Whipple’s Disease (Intestinal Lipodystrophy)
Whipple’s disease is a malabsorption disorder caused when the lining of the small intestine is damaged by Tropheryma whippelii infection. It is also called intestinal lipodystrophy.
- Infection by bacteria called Tropheryma whippelii is the cause of Whipple’s disease.
- Diarrhea, darkening of skin, and inflammation and pain in the joints accompanied by fever, are usual symptoms.
- Biopsies of the lining of the small intestine help diagnose the condition.
- The disease has a progressive nature, and if not treated, a fatal outcome may result.
- The disease can be successfully treated with antibiotic drug therapy but there are chances of recurrence.
Whipple’s disease is prevalent among white men in the age group of 30- 60 years. The infection by Tropheryma whippelii mainly affects the small intestine but it can involve a number of other organs including the heart, brain, lungs, eyes and the joints.
Symptoms
Symptoms of this disease are diarrhea, darkening of the skin, and inflammation and pain in the joints, accompanied by fever. Abdominal pain also may be present. Significant weight loss may result from malabsorption of nutrients from food. Anemia caused by the deficiency of iron and vitamins, may lead to weakness and fatigue. When the lungs are affected by the disease, the pleural membranes enclosing the lungs become inflamed, and fluid accumulation between the layers of the pleural membrane, termed pleural effusion, occurs. Pain while breathing and cough are the symptoms of this condition. Enlargement of lymph nodes occur. Abnormal heart sounds called murmurs may result when the heart is affected. When the disease progresses to the brain, symptoms such as loss of memory, confusion and uncontrollable, random eye movements, may appear. The progression of the disease may culminate in death in the absence of timely medical intervention.
Diagnosis and Treatment
When a person displays the typical symptoms of Whipple’s disease, further investigative procedures are conducted to confirm the disease. Biopsies of the tissue gathered by an endoscope from the small intestine, and a sample from a lymph node which is enlarged, help detect the presence of the bacteria.
Long term antibiotic therapy is the effective treatment for Whipple’s disease. Intravenous administration of ceftriaxone is followed by oral drug therapy with sulfamethoxazole or trimethoprim for a period of 12 months. The antibiotic treatment is effective in curing the disease but recurrence is a possibility.
Share and Enjoy
Tropical Sprue
Tropical sprue is a digestive disorder found in people inhabiting certain tropical regions, in whom the lining of the small intestine become abnormal due to unknown reasons, resulting in malabsorption and associated deficiency diseases.
- Some kind of infection is thought to be the cause of this disease but the exact reason is still unknown.
- Weight loss and anemia, accompanied by chronic diarrhea with light color stools, are the usual symptoms.
- The typical symptoms, and travel history of visiting tropical areas or living in regions where the disease is common, help the doctor in diagnosis.
- Antibiotic drug therapy with tetracycline is the effective treatment for tropical sprue.
Tropical sprue is prevalent in certain geographical areas of tourist interest such as Southeast Asia, southern states of India and the Caribbean islands. The disease can affect the natives of these places as well as visitors. The exact reason for the disease is still not known but it is suspected to be an infectious disease. However, children are found to be unaffected by this condition.
Symptoms and Diagnosis
The characteristic symptoms of tropical sprue include chronic diarrhea with stools of light color. Weight loss is another typical symptom. Nutritional deficiencies resulting from malabsorption precipitate several other symptoms too. Deficiency of Riboflavin (vitaminB2) results in soreness of tongue and cracking of lips and corners of the mouth. Deficiency of iron and folic acid leads to the development of anemia, causing weakness and fatigue.
When a person, who lives in or has recently visited tropical and subtropical regions where the disease is prevalent, displays typical symptoms of tropical sprue as well as symptoms malabsorption such as anemia, the doctor usually investigates this condition. An x-ray is taken, and an endoscopic investigation and biopsy of the lining of the small intestine is done. These tests may show some abnormalities of the lining, but they may not be conclusive evidence of the disease. Other possible causes of similar symptoms such as bacterial infections and parasitic infestations are eliminated, by conducting a stool test, before treatment of tropical sprue is initiated.
Treatment
Antibiotic therapy for an extended period is the standard treatment for tropical sprue. Usually, the drug tetracycline is continued for many months. Vitamin B12 and folate are also given along with the antibiotics. People completely recover from tropical sprue with adequate treatment.
Share and Enjoy
What Is Celiac Sprue (Celiac Disease, Gluten Enteropathy)
Celiac sprue disease is defined as the intolerance to the protein gluten present in grains such as wheat, oats and barley. This hereditary condition results in malabsorption due to the typical alteration caused to the intestinal lining. It is also known as gluten enteropathy, non-tropical sprue or celiac disease.
- Diarrhea, weight loss, and malnutrition are the usual symptoms. Bloated abdomen and bulky stools with foul smell are the common symptoms found in children.
- Inflammation of the lining of the small intestine results from the consumption of foods containing gluten.
- The characteristic symptoms help diagnose the condition and a biopsy of the tissue taken from the intestinal lining confirms the diagnosis.
- Gluten intolerance can be managed by following a gluten-free diet.
Celiac sprue disease is rarely seen in Asian and African countries though it is very common in Europe and America affecting one out of every 250 to 300 people. Southwestern Ireland has the highest incidence of celiac disease with one out of every 150 people being affected. This may point to a genetic factor at play, especially when 10% of those affected are found to have at least one close relative with the same condition. Gluten is a protein mainly found in the food grain wheat. Oats, barley and rye also contain it in lesser amounts. In people who are predisposed to celiac sprue, gluten triggers an immune reaction, resulting in the production of antibodies which damage the lining inside the small intestine. The small intestine has a brush-like lining with numerous projections called villi and micro villi which greatly increase the surface area available for absorption. The damage caused by the antibodies result in flattening of the villi, making the lining smooth and reducing the absorptive capacity of the small intestine. Malabsorption of nutrients results as a consequence.
Symptoms
Diarrhea, weight loss and malnutrition are the typical symptoms of the condition, but some people do not experience any digestive symptoms. A small fraction of people, about one in ten, may have a distressing condition called dermatitis herpetiformis characterized by an itchy and painful skin rash with tiny blisters.
The symptoms of celiac disease may appear early in childhood, but some develop it much later in life. The extent of damage caused to the intestinal wall determines the intensity of the symptoms. The symptoms start appearing in children with the introduction of gluten containing foods in the diet. They may range from mild abdominal discomfort to severe abdominal pain and bloating. Stools may be bulky, with a terrible foul smell, and light in color due to the presence of fat (steatorrhea).
The deficiency diseases resulting from the malabsorption caused by celiac disease precipitate several other symptoms, especially in children. Abnormalities in development, including stunted growth, may affect some children. Deficiency in iron may result in anemia and associated weakness and fatigue. Protein deficiencies may cause fluid accumulation, resulting in edema or swelling of various parts of the body. Pins-and- needles sensation may be felt in the legs and arms due to the damage caused to the nerves by vitamin B12 deficiency. Malabsorption of calcium results in abnormalities in the growth and development of bones as well as that of teeth. Pain in the joints, higher incidence of fractures, discoloration of teeth and severe tooth decay are some of the symptoms of calcium deficiency. Due to the decreased production of estrogen and other hormones, girls who suffer from celiac disease may not attain menarche.
Diagnosis
The characteristic symptoms of celiac sprue help in diagnosing the condition. Testing the levels of the antibodies after consuming gluten also helps in diagnosing the condition. Biopsy of the intestinal lining before and after a person is put on a gluten-free diet helps to confirm the diagnosis. If flattened villi are present in the first sample and significant improvement is observed in the sample taken after the restricted diet, it is a definite indication of celiac disease.
Prognosis and Treatment
Gluten in very small quantities also produce symptoms, hence all foods containing even traces of gluten should be strictly avoided. A gluten-free diet usually revives the normal absorptive surface of the small intestine as the villi regenerate and the brush-like texture of the intestinal lining is restored. The use of gluten in processed foods is so widespread that people on gluten-free diet need the advice of a dietitian to know what foods are safe for them. Since gluten is used in most ice creams and hotdogs, and commercially available sauces and soups, they should carefully check the ingredients listed on the label of foods to avoid accidental exposure.
People who continue to display symptoms of celiac disease even after following a gluten-free diet may have been misdiagnosed or they may be having an advanced form of the disease referred to as refractory celiac sprue. This condition cannot be treated with diet restrictions alone and may require drug therapy using corticosteroids like prednisone. If the drug therapy combined with gluten-free diet does not improve the condition, the patient may have to be fed intravenously. Children who are severely affected by the disease are often fed intravenously for a period, to give rest to the digestive tract and help it recover, before a diet free of gluten is followed.
Avoiding gluten helps in preventing symptoms sprue disease but over a period of time, a small fraction of those with this condition develop a lymphoma of the intestine which may have a fatal outcome. Whether following a strict diet free of gluten helps in reducing the risk of cancers of the intestine is not clear.
Share and Enjoy
What is Lactose Intolerance
What is Lactose intolerance ? Lactose intolerance is defined as the inability to tolerate milk and milk products, resulting from the deficiency of the enzyme lactase necessary for the digestion of the complex sugar lactose contained in milk.
- Diarrhea, abdominal cramps and bloating, flatulence and urgent bowel movements following the consumption of dairy products are common symptoms.
- Children with lactose intolerance usually have chronic diarrhea and fail to gain weight.
- Deficiency of the enzyme lactase, resulting in the indigestion of lactose sugar, is the cause of this condition.
- Appearance of typical symptoms following dairy consumption is the basis of the diagnosis.
- Avoiding foods containing lactose or taking lactase supplements are the treatment options.
Lactose is the main sugar contained in milk, and is consequently present in all other dairy products in varying amounts. The glandular cells in the small intestine’s lining normally secrete the enzyme lactase exclusively for the digestion of lactose. The enzyme lactase is necessary to break down the complex lactose sugar into simple sugars galactose and glucose which are easily absorbed directly into the blood through the wall of the small intestine. When there is a deficiency of lactase, the milk sugar lactose is not broken down into its simpler constituents. When large amount of undigested lactose remains in the small intestine, fluid gets drawn in to facilitate the rapid passage of the undigested matter out of the digestive tract, resulting in diarrhea. In the large intestine, certain types of bacteria cause fermentation of the lactose producing gas and stools acidic in nature.
The main diet of new born babies and infants being milk, they normally have high levels of lactase enzyme. But the lactase levels significantly decrease as the child is weaned, especially in all the people of Asian origin and 80%of Hispanics and blacks. This results in varying levels of lactose intolerance in adults and older children belonging to these ethnic groups. Lactase production in whites of European origin is sustained throughout adult life; hence the incidence of lactose intolerance is as low as 15% in this group. However, it is estimated that more than three fourths of the world’s population has lactose intolerance and in the United States alone, around 50 million people may be having this condition.
There are other sugars such as sucrose and maltose contained in various foods, and intolerance to them can also occur, but it is not as common as lactose intolerance. Deficiency of enzyme sucrose and enzymes isomaltase and maltase result in sucrose intolerance and maltose intolerance respectively, as these complex sugars cannot be absorbed into the blood unless they are broken down into simpler sugars.
Symptoms
Abdominal cramps, bloating of the abdomen, flatulence, and nausea are the most common symptoms which appear on consuming lactose-containing foods. Loud bowel sounds referred to as borborygmy is another symptom. An urgent bowel movement within half an hour to two hours following lactose consumption is also common. Since all dairy products have lactose sugar in varying amounts, people who have lactose intolerance are not able to take milk or milk products. Because of the adverse reactions immediately following the consumption of lactose-rich foods, most people with lactose intolerance learn to avoid those foods which trigger the symptoms, without even being conscious of their condition.
When lactose intolerance is present in children, frequent diarrhea is a common symptom as their diet usually contains a lot of milk and milk products. Their weight gain may be affected as the condition causes rapid passage of food along the digestive tract, greatly reducing the intestine’s capacity to absorb nutrients from the food.
Symptoms of lactose intolerance are not as serious as those of some other malabsorption disorders such as tropical sprue or celiac disease. The symptoms are easily reversible too, on cutting off lactose-containing foods from the diet.
Diagnosis and Treatment
When a person complains of the symptoms typical of lactose intolerance after the consumption of milk or other dairy products, the doctor is alerted to the possibility of this condition. The patient is advised to follow a diet devoid of all types of dairy products for a period of 3 to 4 weeks. If the symptoms disappear during this period, it confirms lactose intolerance without any further testing.
Following a diet devoid of all lactose-containing foods can practically relieve a person of the symptoms of lactose intolerance, though it does not cure the condition. The enzyme lactase is commercially available as tablets which can make the lactose sugar digestible when added to milk. Dairy products which are lactose-reduced may be readily available in shops for the use of lactose intolerant persons. Deficiency of calcium resulting from the lack of dairy products in the diet should be prevented by taking adequate amounts of calcium supplements.
Share and Enjoy
What Is Malabsorption Syndrome
Malabsorption syndrome is the inability of the small intestine to absorb adequate amounts of nutrients from the digested food.
- Weight loss, chronic diarrhea, and passing of bulky stools which may have foul smell and light color, are the usual symptoms
- Infections, certain surgeries, and disorders of the digestive tract, are the usual causes of malabsorption.
- Presence of the characteristic symptoms of malabsorption, and stool tests showing the presence of fat, lead to diagnosis of the condition. Biopsy of the lining of the small intestine helps in confirming the diagnosis.
- Malabsorption is treated according to the cause of the condition.
The small intestine is the main organ for digestion and absorption of nutrients from the food. If the assimilation of nutrients into the blood is disrupted by disorders which affect the normal process, it results in malabsorption and deficiency of those nutrients.
The digestion of food is aided by the digestive juices secreted by the stomach and the intestine. The digestive juices consist of stomach acids and digestive enzymes. Different substances in the digestive juices act on different types of food. If there is an insufficiency of any of the digestive enzymes, it results in the malabsorption of specific types of nutrients. The digestive enzyme lactase, necessary for the digestion and absorption of the complex lactose sugar contained in milk and other dairy products, is produced by the small intestine. Deficiency of the enzyme lactase results in the malabsorption of lactose sugar.
When the food reaching the stomach is not properly mixed with the digestive acids and the digestive enzymes, it may lead to incomplete digestion and malabsorption of nutrients. This type of malabsorption syndrome due to inadequate mixing is very common in people who have undergone surgery to remove a portion of the stomach.
Pancreas is an organ of the digestive system responsible for the production certain digestive enzymes. Due to diseases affecting the pancreas, the enzyme production may be decreased resulting in the malabsorption of certain substances from the food. Inadequate bile production, excessive acid production by the stomach, or the proliferation of certain types of bacteria in the intestines, also may cause malabsorption.
The tissue lining the small intestine has small finger-like projections called villi and microvilli which increase the total surface area available for the absorption of nutrients into the blood. Injury to this lining can result in the malabsorption of a wide range of substances including, proteins, sugars, vitamins and essential minerals. When a portion of the small intestine is diseased or when it is surgically removed as part of treatments for digestive disorders, the area available for absorption of nutrients become greatly reduced, resulting in malabsorption. When the length of the small intestine is reduced, food passes through it too quickly, not giving enough time for the absorption, causing a condition called short bowel syndrome.
Intestinal parasites such as worms and micro organisms, bacterial or viral infections, and certain drugs used to treat the infections, often interfere with absorption. Certain conditions like Crohn’s disease and celiac sprue also cause malabsorption. Inadequate blood supply, lymphomas causing blocks in the lymphatic system of the intestinal wall and alcohol consumption are some of the other causes for malabsorption.
Symptoms
Malabsorption can cause symptoms in two ways. The excessive presence of undigested and unabsorbed materials in the digestive tract is one of them. Deficiency disorders caused by insufficient absorption of specific substances constitute the other.
When fats are not broken down and absorbed by the small intestine, it results in a condition called steatorrhea, commonly known as fatty stools. The stool may be bulky and light in color with a foul smell. The sticky stool may remain stuck to the toilet bowl and be difficult to flush away or it may float in the water in the bowl. Bloating of the abdomen, excessive gas formation and explosive diarrhea may result from the malabsorption of sugars like lactose.
Malabsorption may result in the deficiency of a specific nutrient such as certain vitamins or proteins or a general nutritional deficiency. Weight loss is very common among people who have malabsorption. Other symptoms may depend on specific deficiencies; for example, edema, hair loss and dry skin caused by the deficiency of proteins.
Diagnosis
Malabsorption is investigated when a person comes to the doctor with symptoms such as chronic diarrhea and significant weight loss without obvious reasons. Deficiency diseases also may be present. However, the symptoms of malabsorption may not be easily recognizable in older people.
The stool passed by a person having malabsorption usually contains undigested food particles and visible fat. Too much fat in the stool is an indication of inadequate bile production, a condition common in people with jaundice. Food passing through the digestive tract too quickly, without sufficient time for the digestive processes to act on it, results in incomplete digestion and presence of food particles in the stool. Testing of the stool in the laboratory may detect the presence of intestinal parasites interfering with the absorption of nutrients. The amount of fat in the stool is measured in the lab. If it is above 7grams per day in a three day’s collection of stool samples, malabsorption is confirmed. There are lab tests for malabsorption, specific to individual substances like Vitamin B12 or milk sugar lactose.
An endoscopic procedure, in which a clipper-tipped endoscope is threaded down the digestive tract to reach the small intestine, helps collect a tissue sample from the lining of the intestine. The sample collected is tested for abnormalities that may be causing the malabsorption.
If malabsorption syndrome is suspected to be resulting from the inadequate secretion of pancreatic enzymes, pancreatic function tests are conducted. A thin tube passed into the small intestine draws out the digestive juice which contains the secretions of the pancreas as well. Testing of the ingredients of the collected fluid may show if pancreatic insufficiency is present. Sometimes a test, which involves swallowing a fixed quantity of a substance digestible by the pancreatic enzymes and then measuring the byproducts in the urine, helps in assessing the function of the pancreas.