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Introduction

Protein, fats, and carbohydrates (macronutrients) normally are absorbed in the small intestine; the small bowel also absorbs about 80% of the eight to ten liters of fluid ingested daily. There are many different conditions that affect fluid and nutrient absorption by the intestine. A fault in the digestive process may result from failure of the body to produce the enzymes needed to digest certain foods. Congenital structural defects or diseases of the pancreas, gall bladder, or liver may alter the digestive process. Inflammation, infection, injury, or surgical removal of portions of the intestine may also result in absorption problems; reduced length or surface area of intestine available for fluid and nutrient absorption can result in malabsorption. Radiation therapy may injure the mucosal lining of the intestine, resulting in diarrhea that may not become evident until several years later. The use of some antibiotics can also affect the bacteria that normally live in the intestine and affect intestinal function.

Causes and symptoms

Protein, fats, and carbohydrates (macronutrients) normally are absorbed in the small intestine; the small bowel also absorbs about 80% of the eight to ten liters of fluid ingested daily. There are many different conditions that affect fluid and nutrient absorption by the intestine. A fault in the digestive process may result from failure of the body to produce the enzymes needed to digest certain foods. Congenital structural defects or diseases of the pancreas, gall bladder, or liver may alter the digestive process. Inflammation, infection, injury, or surgical removal of portions of the intestine may also result in absorption problems; reduced length or surface area of intestine available for fluid and nutrient absorption can result in malabsorption. Radiation therapy may injure the mucosal lining of the intestine, resulting in diarrhea that may not become evident until several years later. The use of some antibiotics can also affect the bacteria that normally live in the intestine and affect intestinal function.

Diagnosing Malabsorption

Various tests are available to diagnose malabsorption.

Stool examination: People suffering from malabsorption often have high fat content in their stools. Also, stools provide evidence of undigested food.

Absorption tests: Blood tests measuring various levels of nutrients are taken to determine whether absorption is taking place. In general, various levels of specific substances such as glucose in the blood increase after eating if proper digestion and absorption occur.

X-rays: X-rays of the intestine may be taken to determine whether the intestine is damaged, or if blockages are present that may inhibit absorption.

Biopsy: A biopsy of the intestine may be taken to determine whether the intestine is damaged, or whether bacteria are causing the problem.

Risk factors

Risk factors for malabsorption syndrome include:

Premature birth

Family history of malabsorption or cystic fibrosis

Use of certain drugs, such as mineral oil or other laxatives

Travel to foreign countries

Intestinal surgery, including bowel transplantation

Excess alcohol consumption.

The most common symptoms of malabsorption include: Anemia, with weakness and fatigue due to inadequate absorption of vitamin B12, iron, and folic acid

Diarrhea, steatorrhea (excessive amount of fat in the stool), and abdominal distention with cramps, bloating, and gas due to impaired water and carbohydrate absorption, and irritation from unabsorbed fatty acids. The individual may also report explosive diarrhea with greasy, foul-smelling stools.

Edema (fluid retention in the body's tissues) due to decreased protein absorption

Malnutrition and weight loss due to decreased fat, carbohydrate, and protein absorption. Weight may be 80-90% of usual weight despite increased oral intake of nutrients.

Muscle cramping due to decreased vitamin D, calcium, and potassium levels

Muscle wasting and atrophy due to decreased protein absorption and metabolism

Perianal skin burning, itching, or soreness due to frequent loose stools.

Irregular heart rhythms may also result from inadequate levels of potassium and other electrolytes. Blood clotting disorders may occur due to a vitamin K deficiency. Children with malabsorption syndrome often exhibit a failure to grow and thrive.

Several disorders can lead to malabsorption syndrome, including cystic fibrosis, chronic pancreatitis, lactose intolerance, and gluten enteropathy (nontropical sprue.)

Tropical sprue is a malabsorptive disorder that is uncommon in the United States, but seen more often in people from the Caribbean, India, or southeast Asia. Although its cause is unknown, it is thought to be related to environmental factors, including infection, intestinal parasites, or possibly the consumption of certain food toxins. Symptoms often include a sore tongue, anemia, weight loss, along with diarrhea and passage of fatty stools.

Whipple's disease is a relatively rare malabsorptive disorder, affecting mostly middle-aged men. The cause is thought to be related to bacterial infection, resulting in nutritional deficiencies, chronic low-grade fever, diarrhea, joint pain, weight loss, and darkening of the skin's pigmentation. Other organs of the body may be affected, including the brain, heart, lungs, and eyes.

Short bowel syndromes—which may be present at birth (congenital) or the result of surgery—reduce the surface area of the bowel available to absorb nutrients and can also result in malabsorption syndrome. Congenital short bowel syndrome occurs in about 24 out of 100,000 live births and has a high mortality rate (about 38%).

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