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Malabsorption

 

Malabsorption involves problems with the body's ability to take in nutrients from food.

Causes

Many diseases can cause malabsorption. Most often, malabsorption involves problems absorbing certain sugars, fats, proteins, or vitamins. It can also involve an overall problem with absorbing food.

Problems or damage to the small intestine that may lead to problems absorbing important nutrients. These include:

  • Celiac disease
  • Crohn disease
  • Damage from radiation treatments
  • Overgrowth of bacteria in the small bowel
  • Parasite or tapeworm infection
  • Surgery that removes all or part of the small intestine

Enzymes produced by the pancreas help absorb fats and other nutrients. A decrease of these enzymes makes it harder to absorb fats and certain nutrients. Problems with the pancreas may be caused by:

  • Cystic fibrosis
  • Infections or swelling of the pancreas
  • Trauma to the pancreas
  • Surgery to remove part of the pancreas

Some of the other causes of malabsorption include:

  • AIDS and HIV
  • Certain medicines (tetracycline, some antacids, some medicines used to treat obesity, colchicine, acarbose, phenytoin)
  • Gastrectomy and surgical treatments for obesity
  • Cholestasis
  • Chronic liver disease
  • Cow's milk protein intolerance
  • Soy milk protein intolerance

Symptoms

 

In children, current weight or rate of weight gain is often much lower than that of other children of similar age and gender. This is called failure to thrive. The child may not grow and develop normally.

Adults may also have failure to thrive, with weight loss, muscle wasting, weakness, and even problems thinking.

Changes in the stools are often present, but not always.

Changes in the stools may include:

  • Bloating, cramping, and gas
  • Bulky stools
  • Chronic diarrhea
  • Fatty stools (steatorrhea)

 

Exams and Tests

 

Your health care provider will do an exam. Tests that may be done include:

  • Blood and urine tests
  • CT scan of the abdomen
  • Hydrogen breath test
  • MR or CT enterography
  • Schilling test for vitamin B12 deficiency
  • Secretin stimulation test
  • Small bowel biopsy
  • Stool culture or culture of small intestine aspirate
  • Stool fat testing
  • X-rays of the small bowel or other imaging tests

 

Treatment

 

Treatment depends on the cause and is aimed at relieving symptoms and ensuring the body receives enough nutrients.

A high-calorie diet may be tried. It should supply:

  • Key vitamins and minerals, such as iron, folic acid, and vitamin B12
  • Enough carbohydrates, proteins, and fats

If needed, injections of some vitamins and minerals or special growth factors will be given. Those with damage to the pancreas may need to take pancreatic enzymes. Your provider will prescribe these if necessary.

Medicines to slow down the normal movement of the intestine can be tried. This may allow food to remain in the intestine longer

If the body is not able to absorb enough nutrients, total parenteral nutrition (TPN) is tried. It will help you or your child get nutrition from a special formula through a vein in the body. Your provider will select the right amount of calories and TPN solution. Sometimes, you can also eat and drink while getting nutrition from TPN.

 

Outlook (Prognosis)

 

The outlook depends on what is causing the malabsorption.

 

Possible Complications

 

Long-term malabsorption can result in:

  • Anemia
  • Gallstones
  • Kidney stones
  • Thin and weakened bones

 

When to Contact a Medical Professional

 

Call your provider if you have symptoms of malabsorption.

 

Prevention

 

Prevention depends on the condition causing malabsorption.

 

 

References

Högenauer C, Hammer HF. Maldigestion and malabsorption. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 104.

Semrad CE. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 140.

 
  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Cystic fibrosis

    Cystic fibrosis - illustration

    Cystic fibrosis is the most common cause of chronic lung disease in children and young adults, and the most common fatal hereditary disorder affecting white people in the United States.

    Cystic fibrosis

    illustration

  • Digestive system organs

    Digestive system organs - illustration

    The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

    Digestive system organs

    illustration

    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Cystic fibrosis

      Cystic fibrosis - illustration

      Cystic fibrosis is the most common cause of chronic lung disease in children and young adults, and the most common fatal hereditary disorder affecting white people in the United States.

      Cystic fibrosis

      illustration

    • Digestive system organs

      Digestive system organs - illustration

      The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

      Digestive system organs

      illustration

    Tests for Malabsorption

     

       

      Review Date: 5/11/2016

      Reviewed By: Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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