Malabsorption Syndrome: Causes, Symptoms, Diagnosis and Management

Malabsorption Syndrome: Causes, Symptoms, Diagnosis & Management

Question. Write a Short Note On Malabsorption Syndrome.
Or
What Is Malabsorption Syndrome, Causes Of Malabsorption, Clinical Features, And Its Management?

Answer. Malabsorption syndrome comprises a large number of pathological conditions in which there is a disturbance of processes by which nutrients are transferred from the lumen of the intestine into circulation.

“Understanding malabsorption syndrome through FAQs: Causes, symptoms, diagnosis, and management explained”

Etiology of Malabsorption

• Stomach:
  • Precipitate emptying after postgastrectomy dumping.
  • Lack of intrinsic factor.
  • Excess acid secretion in Zollinger­Ellison syndrome.
• Pancreatic: Inadequate enzyme and bicarbonate secretion.
• Biliary: Due to defective micelle formation.
• Endocrine diseases
• Parasitic or drug.
  Various diseases, along with their etiologies, can cause malabsorption as:
• Disorders of intraluminal digestion
  • Pancreatic enzyme deficiency in chronic pancreatitis, cystic fibrosis, and pancreatic carcinoma
  • Disturbances of gastric function after gastroenterostomy and partial gastrectomy
  • Deficiency of bile acids in Crohn’s disease, resection of the terminal ileum, stagnant loop syndrome, or blind loop syndrome.
• Disorders of transport in the intestinal mucosal cell
  • With histologically abnormal mucosa (infiltration, inflammation, or infection of mucosa) in coeliac disease, tropical sprue, lymphoma, Whipple’s disease, giardiasis and radiation enteritis
  • With histologically normal mucosa (genetic diseases) in lactase deficiency, pernicious anemia
  • Disorders of transport from mucosal cells in abdominal lymphoma, tuberculosis, telangiectasia of mesenteric lymphatics, beta hypoproteinemia,
  • Impaired nutrient uptake in lymphatic obstruction, cardiac heart failure, and pericarditis
  • Miscellaneous: Diabetes mellitus, hyperthyroidism, hyperparathyroidism

“Factors influencing success with malabsorption syndrome knowledge: Q&A”

Clinical Features of Intestinal Mucosal Cell

• *Steatorrhea presents symptoms.
• Diarrhea or abdominal discomfort.
• Nutritional deficiencies, i.e., deficiency of vitamins A, D, B12, and K
• General features include anemia, sore mouth, loss of weight, fatigue, and lethargy.
• Bone pain may be present.
• Skin changes like pellagra are present
• The patient also suffers from peripheral neuropathy, irritability, and lack of confidence.

“Common challenges in diagnosing and managing malabsorption syndrome effectively: FAQs provided”

Investigations of intestinal mucosal cells

Tests are carried out to detect nutritional deficiencies.
These tests indicate the malabsorption of a particular nutrient and not its cause.

• Fecal fat stimulation: It confirms steatorrhea and fat malabsorption.
  Sudan III stain may show an increase in stool fat. Quantitative estimation of fat in the stool is more reliable and sensitive.
  A 72­hour stool collection while the patient is on a defined diet is used for fat estimation.
  Excretion of more than 10 g of fat per day suggests fat malabsorption.
• Schilling test: This is useful in the diagnosis of cobalamin (B12) malabsorption and its causes, like pernicious anemia, chronic pancreatitis, achlorhydria, and bacterial
  overgrowth. In this test, radio­labelled cobalamin (l mg 68°C) should be given orally, and its excretion in urine is measured. 1 mg cobalamin is administered intramuscularly to saturate hepatic binding sites so that all radiolabelled cobalamin is excreted in the urine.
  The test is abnormal if less than l0% of the radio­labelled cobalamin is excreted in the urine in 24 hours.
  This will help in differentiating the various defects responsible for the malabsorption of cobalamin.

“Steps to explain malabsorption syndrome: Causes vs symptoms vs diagnosis vs management: Q&A guide”

• D-xylose test: It detects carbohydrate malabsorption. 25 g of D­xylose is given orally, and its excretion is measured in urine.
  Excretion of less than 4.5 g in 5 hours is suggestive of malabsorption.
• Upper gastrointestinal endoscopy and biopsy of small intestinal mucosa: It is essential for the diagnosis of conditions like tropical sprue, celiac sprue, Whipple’s disease, and Crohn’s
  disease.
• Barium meal contrast radiography: Radiological assessment of the small intestine with barium contrast is helpful in the evaluation of structural abnormalities in Crohn’s disease,
  diverticulae and strictures.
• Pancreatic exocrine functions: They should be carried out in patients with steatorrhea.
• Serological studies: In some of the conditions, such as celiac sprue and pernicious anemia, autoantibodies are detected.
• Small intestinal biopsy (duodenal or jejunal): It is carried out for diagnostic purposes.

“Importance of studying malabsorption syndrome for healthcare professionals: Questions explained”

Management of the intestinal mucosal cell

• Diet: A high-protein and low-fat diet is taken.
• Digestants: Pancreatic enzyme preparations are administered after meals.
• Treatment of anemia: All three hematinic vitamins B12, folic acid, and iron are given.
• Vitamin supplements: Vitamin B complex and vitamin D are given.
• Treatment of diarrhea: Codeine and loperamide are administered.
• Steroids: Prolonged therapy with prednisolone is given.
• Elimination of bacterial overgrowth: Tetracycline 250 mg TDS for one week.