A Family Doctor's Tale- MALABSORPTION SYNDROME

DOC I HAVE MALABSORPTION SYNDROME

Malabsorption syndrome is a disease resulting from poor intestinal absorption of nutrients, vitamins and minerals no matter how much the patient eats.

Malabsorption syndrome is usually caused by the following:

A.Intraluminal defects
1. pancreatic enzymes or bile salt deficiencies

2.gastric or intestinal resection as a result of cancer or obstruction

3.bacterial overgrowth in the intestine resulting in less nutrients absorption


4.acid hypersecretion(Zollinger-Ellison) syndrome

B.Intestinal Mucosal Defects
1.Tropical or non tropical sprue characterized by abnormalities of the intestinal villi resulting in poor absorption of food

2.parasitic disease of the intestinal such as tape-worms which feeds through the mucosa of the intestine


3.tuberculosis of the intestine can cause damage to inner lining of intestine impeding absorption of food

4.food allergies like celiac disease, crohn's disease, irritable bowel syndrome, lactose intolerance, Whipple's disease


5.Chemotherapy, drug abuse, radiation can damage the mucosa of the intestines

C.Intestinal lymphatic abnormalities
1.lymphanigiectasia causing obstruction to the lymphatic system


2.congestive heart failure leading to poor lymphatic circulation


3.constrictive pericarditis also affects the lymphatic system


Persons who has Malabsorption syndrome has the following symptoms:
1.Weight loss

2.anorexia or loss of appetite

3.abdominal distension and bloating

4.diarrhea

5.steatorrhea(pale bulky frothy stools) usually frequent

6.muscle wasting

7.weakness and fatigue

8.depression and poor concentration

9.dry skin, anal itch and thinning hair

10.glossitis,visual difficulties


Signs:
1.vitamin deficiency especially vitamin B12 and K and folic acid

2.mineral deficiencies and anemia leads to malaise and muscle cramps


3.Low protein may lead to edema  and muscle wasting


Diagnosis can usually be made by :
1.History of weight loss

2.Steatorrhea - measurement of fecal fat is low

3.D-xylose test is abnormal indicating poor carbohydrate absorption

4.Pancreatic function tests by duodenal aspiration

5.Tests for bacterial overgrowth such as:
bile acid breath test
jejunal cultures
urinary tryptophan metabolites

6.Intestinal biopsy

Treatment depends on the cause:

Non-medicinal :
1.Intravenous fluids, electrolytes, minerals, vitamins

2.Intravenous nutrients and feeding

3.Gluten free diet

4.Restriction of dietary fat

5.Medium chain triglycerides

6.Lactose free diet

7.Probiotics helps to replace the bacteria overgrowth in the intestines and restore the bacteria flora in the bowels

8.Small frequent feeding of food helps digestion of food


Medicinal:
1.Symptomatic treatment of abdominal pain(anticholinergics)and diarrhea(Imodium)

2.Pancreatic enzymes for pancreatic deficiency

3.Folic acid, vitamins and minerals replacements

4.Antibiotics and anti-parasitics for intestinal infections.

5.Long term tetracycline is important in the treatment of Whipple's Disease


Prognosis depends on the underlying cause.

Most patients usually recover if appropriately treated

Recurrence is quite common.