What is malabsorption?
Malabsorption is the state that occurs when passing through a lack of digestion or absorption of nutrients are not adequately absorbed into the blood from the gastrointestinal tract. Or a disturbance of digestion, absorption and transport of nutrients.
This may relate to a particular or to a wide range of nutrients. There may be malnutrition or anemia.
Malabsorption may be divided into three groups:
- selective malabsorption, such as lactose intolerance;
- partial malabsorption, such as beta-lipoproteinemia, and
- full malabsorption such as celiac disease.
Digestion
The gastrointestinal tract has the task to digest the food and nutrients in the blood, to incorporate the (absorption). The main nutrients are: sugars (resulting from the digestion of carbohydrates), fatty acids (produced by the digestion of fat), amino acids (resulting from the digestion of protein), vitamins, trace elements, water and electrolytes.
Digestion begins in the mouth, where food is reduced by chewing. Then, it is made fine in the stomach and the small intestine. The actual digestion takes place in the intestines by means of enzymes, originating from the stomach, the pancreas and the intestine wall. Also, bile from the liver plays a role. The end products are finally absorbed through the intestinal villi of the intestines.
Causes of malabsorption
Malabsorption may be due to:
- damage to the lining of the small intestine
- congenital or acquired reduction of absorbent surface
- disorders of the enzymatic degradation
- disorders of the transport of water and salts,
- insufficient activity of the pancreas
- disruption of the reuptake of bile salts
Malabsorption symptoms
The presentation of malabsorption is dependent on the underlying disease. In severe malabsorption, there will be complaints of the gastro-intestinal tract are, in less severe forms, which may be missing.
- Diarrhea, often high in fat (steatorrhea), is common.
- Weight loss may be significant, in spite of ingestion of large amounts of food.
- Delayed growth, malaise, leaving onset of puberty,
- Edema by protein deficiency
- Anemia, vitamin B12, folic acid and iron, causing fatigue and weakness.
- Muscle cramps due to lack of vitamin D, which also leads to osteomalacia and osteoporosis
- Bleeding Tendency by deficiency of vitamin K and other coagulation factors.
Diagnosis
There is no special text for malabsorption. As with most diseases, the investigation is guided by symptoms and signs.
Blood tests
- Routine blood test can detect anemia, high ESR or low albumin.
- One can also specific vitamins, such as vitamin D or trace elements such as to determine zinc. Fat-soluble vitamins (A, D, E & K) are decreased in the malabsorption of fat. Increased prothrombin time may indicate vitamin K deficiency.
- Antibodies to gluten. To exclude celiac disease may be determined by TTG antibodies (anti-tissue transglutaminase).
Examination of the stool
- Microscopic examination can demonstrate parasites
- Microscopic study of fat globules
- Low elastase indicates pancreatic insufficiency. Determination of pancreatic enzymes is possible today.
Policy
The treatment is largely determined by the underlying cause.
- Complement via an infusion of nutrient deficiencies, salts, or water may be necessary. Often the advice of a dietician needed here.
- Addition of enzymes from the pancreas may be necessary.
- Adjustment of the diet is sometimes important. Avoiding foods with proven intolerance is sometimes necessary for life.
- For a disturbed intestinal flora, an antibiotic may be necessary.
- Cholestyramine binds bile acids and can reduce diarrhea in malabsorption of bile salts.