Malabsorption: Causes, Symptoms and Treatment
Malabsorption refers to the impaired absorption of nutrients in the intestine. It can lead to nutritional deficiencies, weight loss, and a range of related health conditions.
Wissenswertes über "Malabsorption"
Malabsorption refers to the impaired absorption of nutrients in the intestine. It can lead to nutritional deficiencies, weight loss, and a range of related health conditions.
What is Malabsorption?
Malabsorption is a condition in which the small intestine fails to properly absorb nutrients, vitamins, minerals, or fluids into the bloodstream. The term derives from the Latin prefix mal- (poor, inadequate) and absorptio (absorption). Malabsorption may affect a single nutrient -- such as lactose or iron -- or involve a broad impairment of digestion and absorption. When left untreated, it can result in serious nutritional deficiencies and long-term health complications.
Causes
Malabsorption can arise from a wide variety of conditions affecting different parts of the digestive system:
- Small intestinal disorders: Coeliac disease (gluten-sensitive enteropathy), Crohn's disease, Whipple's disease, tropical sprue
- Short bowel syndrome: Following surgical removal of large sections of the small intestine
- Enzyme deficiencies: Lactase deficiency (lactose intolerance), exocrine pancreatic insufficiency
- Biliary disorders: Reduced bile acid production or secretion, e.g. in liver cirrhosis or cholestasis
- Infections and parasites: Giardia lamblia infection, small intestinal bacterial overgrowth (SIBO)
- Medications: Long-term use of certain antibiotics, laxatives, or cholestyramine
- Lymphatic disorders: Intestinal lymphangiectasia
Symptoms
The symptoms of malabsorption vary depending on which nutrients are not being adequately absorbed:
- General symptoms: Weight loss, fatigue, weakness, reduced physical performance
- Gastrointestinal symptoms: Chronic diarrhea, fatty stools (steatorrhoea), bloating, abdominal cramps, foul-smelling stools
- Nutritional deficiency symptoms: Anaemia (iron, vitamin B12, or folate deficiency), osteoporosis (calcium and vitamin D deficiency), night blindness (vitamin A deficiency), increased bleeding tendency (vitamin K deficiency), oedema (protein deficiency)
- In children: Delayed growth and failure to thrive
Diagnosis
Diagnosing malabsorption requires a thorough medical history, physical examination, and a range of diagnostic tests:
- Blood tests: Measurement of haemoglobin, albumin, vitamins (B12, D, folate), minerals (iron, calcium, magnesium), zinc, and inflammatory markers
- Stool tests: Detection of fat in the stool (steatorrhoea testing), stool cultures to rule out infectious causes
- Breath tests: Hydrogen breath test to diagnose lactose intolerance or bacterial overgrowth
- Imaging: Ultrasound, MRI enterography, or CT scan of the abdomen
- Endoscopy and biopsy: Gastroscopy or colonoscopy with tissue sampling, e.g. to confirm coeliac disease or Crohn's disease
- Pancreatic function tests: Faecal elastase to assess exocrine pancreatic function
Treatment
Treatment of malabsorption is primarily directed at the underlying cause:
- Dietary modifications: Gluten-free diet for coeliac disease, low-lactose diet for lactase deficiency
- Enzyme replacement therapy: Pancreatic enzyme supplementation for exocrine pancreatic insufficiency
- Nutritional supplementation: Targeted replacement of deficient vitamins (e.g. B12, D, K), minerals (e.g. iron, calcium), and trace elements
- Antibiotics: For small intestinal bacterial overgrowth (e.g. rifaximin)
- Treatment of the underlying condition: Immunosuppressants or biologics for Crohn's disease, bile acid replacement for bile acid deficiency
- Parenteral nutrition: In severe cases such as short bowel syndrome, intravenous nutrient delivery may be required
References
- Longo DL et al. (eds.) - Harrison's Principles of Internal Medicine, 21st edition. McGraw-Hill Education, 2022.
- World Gastroenterology Organisation (WGO) - Global Guidelines: Malabsorption. Available at: https://www.worldgastroenterology.org (accessed 2024).
- Bai JC, Ciacci C - World Gastroenterology Organisation Global Guidelines: Celiac Disease. Journal of Clinical Gastroenterology, 2017.
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Related search terms: Malabsorption + Malabsorption syndrome + Nutrient malabsorption