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Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

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Malabsorption

The small intestine is lined with tiny projections, called villi, that afford optimal surface area for the absorption of fluids and nutrients.

What is it?

Malabsorption is a term for any condition in which one or more essential nutrients or minerals are not properly digested or absorbed by the intestines. Lipids (fats) are the most commonly malabsorbed nutrients, but proteins, carbohydrates, electrolytes (such as sodium and potassium), vitamins, and minerals (such as iron and calcium) may be poorly absorbed as well. A multitude of different disorders can result in malabsorption; outlook depends upon the success in treating the underlying cause. Symptoms may range from bouts of gas, diarrhea, and stomach cramps that occur only when certain foods are consumed and maldigested (see Lactose Intolerance for more information) to emaciation and other signs of severe malnutrition.

What Causes It?

  • Any defect in the functioning of the digestive system (for example, an inadequate production of bile salts by the liver, or digestive enzymes by the pancreas, or cells lining the intestine, or damage to the intestinal absorptive cells) can prevent the proper breakdown of foods and the absorption of adequate amounts of nutrients.
  • A major cause of malabsorption is chronic pancreatitis (often related to alcohol abuse), which may lead to decreased secretion of pancreatic enzymes that digest food—especially fats and protein.
  • Inflammation or other abnormalities (see Crohn's Disease and Amyloidosis for more information) in the mucous membrane that lines the intestine may prevent nutrients from being absorbed through the intestinal wall.
  • Surgery to remove diseased segments of the intestine may result in an inadequate amount of absorptive surface. This is called short bowel syndrome.
  • Infections (including acute infectious enteritis) and tapeworm or other parasites may inhibit proper digestion. Some infections may result in an overgrowth of intestinal bacteria, which may also lead to malabsorption. Those with AIDS are particularly prone to malabsorption, since the disease damages immune defenses against secondary infections that may cause digestive problems.
  • Any obstruction of the lymphatic system, as may occur with lymphomas and tuberculosis, may also interfere with nutrient absorption.
  • Certain cardiovascular problems may result in malabsorption (see Congestive Heart Failure and Pericarditis for more information).
  • Certain medications may induce malabsorption. These medications include cholestyramine (a cholesterol- lowering drug), neomycin (an antibiotic), colchicine (an antigout drug), and certain laxatives.
  • Other diseases, including diabetes mellitus, hyperand hypothyroidism, and carcinoid syndrome, may cause malabsorption for reasons that are unclear.

Prevention

  • Malabsorption is preventable only when the underlying cause (such as an infection) is preventable.

Diagnosis

  • Patient history, including use of alcohol, and physical examination.
  • Blood tests for anemia and other nutritional deficiencies.
  • Stool samples looking for undigested fat.
  • Culture of the microorganisms inhabiting the intestine.
  • Breath tests to detect lactose intolerance or bacterial overgrowth in the small intestine.
  • Biopsy of intestinal tissue (may be taken during endoscopy; that is, visual inspection of the upper small intestine with a flexible, lighted scope).
  • Upper GI (gastrointestinal) and small bowel series (use of barium to create a clear image of the intestine on x-ray).

How to Treat It

  • In some cases the only treatment necessary is to avoid certain foods that trigger or exacerbate symptoms. For example, those with lactose intolerance should avoid milk products; those with nontropical sprue (celiac disease) may be cured by avoiding all foods containing gluten (a protein found in wheat, rye, oats, and barley).
  • The underlying disorder causing malabsorption must be diagnosed and treated. For instance, antibiotics are given to cure an infection.
  • Nutritional supplements may be prescribed. Common supplements include calcium, magnesium, iron, and vitamins A, D, E, and K.
  • Pancreatic enzymes may be prescribed to correct insufficient production of them.
  • Corticosteroids may improve absorption in some cases of inflammatory diseases.
  • In many cases a high carbohydrate, low-fat diet is recommended; it is easiest to digest and absorb.

When to Call a Doctor

  • Call a doctor if diarrhea or other digestive problems persist for longer than three days.