Malabsorption

Definition

This is impaired absorption of nutrients from the GI tract.

Description

Many different conditions and circumstances can affect the ability of the small intestine to absorb nutrients adequately. Examples include a fault in the digestive process, such as a failure to produce enzymes needed to break down certain foods; structural defects or tumors in the intestine itself; inflammatory processes, intestinal infections, and other diseases; and congenital defects.

Injury or surgical removal of portions of the small intestine also may result in absorption problems.

Causes and Risk Factors

Specific malabsorption disorders include:

Lactose intolerance is a common disorder caused by a lack of a specific enzyme necessary to break down a sugar in milk, resulting in diarrhea, cramps, and gas.

Celiac disease is a hereditary disorder involving an intolerance to gluten, a protein found in wheat and rye flours. Symptoms include a failure to grow and the passage of fatty, foul-smelling stools that float to the top of the toilet water. The disorder often can be diagnosed on the basis of symptoms and confirmed by examining a small sample of intestinal tissue. As the disease progresses, the fingerlike projections that line the intestinal walls, and from which nutrients are absorbed into the bloodstream, become flattened and smooth. Treatment involves consuming a gluten-free diet.

Tropical sprue is uncommon in the U.S. Symptoms include anemia and other nutritional deficiencies, weight loss, and diarrhea. A sore tongue and passage of fatty stools are common.

Whipple's disease is a relatively rare disorder, mostly affecting middle-aged men. Symptoms include severe malabsorption, nutritional deficiencies, chronic low-grade fever, diarrhea, and joint pain.

Other disorders - in addition to specific intestinal abnormalities or deficiencies, a number of other disorders can hinder absorption. Scleroderma, intestinal lymphoma, liver disease, pancreatic disease, and bacterial overgrowth are among the numerous conditions that can hinder absorption from the small intestine. Intestinal damage from radiation therapy or certain drugs also may affect absorption.

Symptoms

Malabsorption syndrome is a complex of symptoms resulting from disorders in the intestinal absorption of nutrients, characterized by anorexia, weight loss, gas, bloating of the abdomen, muscle cramps, and steatorrhea (fatty stools). Anemia, weakness, and fatigue occur because iron, folic acid, and vitamin B12 are not absorbed in sufficient amounts.

Diagnosis

Your physician will take a complete medical history, perform a physical exam, and may perform blood tests and stool studies. In some cases, further testing may include taking an intestinal biopsy (a small sample of tissue) for analysis.

Treatment

Treatment varies by diagnosis but may include dietary restrictions and medications such as anti-diarrheals, antibiotics, or enzyme replacements. Surgery may be indicated in certain cases.

Questions to Ask Your Doctor

Is there a problem with absorption?

Is this a specific disease such as celiac sprue?

What are treatment options?

What change in diet is called for?

What can be done to minimize the symptoms?