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Malabsorption – Causes, Symptoms and Treatment

Malabsorption occurs when the intestine cannot adequately absorb nutrients. It leads to deficiencies, digestive complaints, and various systemic symptoms.

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Things worth knowing about "Malabsorption"

Malabsorption occurs when the intestine cannot adequately absorb nutrients. It leads to deficiencies, digestive complaints, and various systemic symptoms.

What is Malabsorption?

Malabsorption refers to the impaired uptake of nutrients, vitamins, minerals, fluids, or other essential substances from the intestine into the bloodstream. Under normal conditions, the small intestine absorbs these substances through its mucosal lining and delivers them to the body. When this process is disrupted, nutritional deficiencies develop that can affect numerous organs and bodily functions.

Causes

Malabsorption can result from a wide range of diseases and contributing factors:

Coeliac disease: An immune reaction to gluten damages the intestinal villi, reducing the absorptive surface of the small intestine.
Crohn disease: A chronic inflammatory bowel disease that can affect the entire gastrointestinal tract.
Short bowel syndrome: After surgical removal of sections of the intestine, less absorptive surface is available.
Chronic pancreatitis: Insufficient digestive enzymes from the pancreas impair the breakdown and absorption of nutrients.
Lactase deficiency: The absence of the enzyme needed to digest lactose leads to impaired absorption.
Infections and parasitic infestations: For example, caused by Giardia lamblia or certain bacteria.
Medications: Some drugs can inhibit the absorption of specific nutrients.

Symptoms

Symptoms of malabsorption vary depending on which nutrients are affected:

Diarrhoea, often fatty and foul-smelling (steatorrhoea)
Bloating and abdominal cramps
Weight loss despite adequate food intake
Fatigue and exhaustion
Anaemia due to iron or vitamin B12 deficiency
Bone pain or increased fracture risk due to calcium and vitamin D deficiency
Skin changes, hair loss, or impaired wound healing due to zinc deficiency
Oedema (fluid retention) due to protein deficiency

Diagnosis

Several investigations are used to diagnose malabsorption:

Blood tests: Detection of nutrient deficiencies (e.g. iron, vitamin B12, folic acid, vitamin D, albumin)
Stool tests: Detection of fatty stools (steatorrhoea) or inflammatory markers
Breath tests: Such as the lactose breath test or H2 breath test to identify fermentation processes
Endoscopy with biopsy: Collection of tissue samples from the small intestine to assess the mucosal lining
Imaging procedures: Ultrasound, CT, or MRI to visualise the pancreas, intestine, and other organs

Treatment

Treatment is directed at the underlying cause:

Dietary measures: Gluten-free diet for coeliac disease, low-lactose diet for lactase deficiency
Enzyme replacement therapy: Digestive enzyme capsules for pancreatic insufficiency
Supplementation: Targeted replacement of deficient nutrients (e.g. iron, vitamin B12, vitamin D, calcium) orally or by infusion
Pharmacological therapy: Anti-inflammatory medications for chronic inflammatory bowel disease
Antibiotics or antiparasitic agents: For infectious causes
Parenteral nutrition: In severe cases, nutrients may need to be delivered directly into the bloodstream via a vein

References

World Gastroenterology Organisation (WGO) – Global Guidelines: Malabsorption (2023). Available at: https://www.worldgastroenterology.org
Kasper, D. L. et al. – Harrison's Principles of Internal Medicine, 21st edition, McGraw-Hill Education (2022)
Rubio-Tapia, A. et al. – American College of Gastroenterology Guidelines for Diagnosis and Management of Coeliac Disease. American Journal of Gastroenterology, 118(1), 2023. Available at: https://pubmed.ncbi.nlm.nih.gov

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