A fault in the digestive process may result from failure of the body to produce the enzymes needed to digest certain foods. Congenital structural defects or diseases of the pancreas, gall bladder, or liver may alter the digestive process. Inflammation, infection, injury, or surgical removal of portions of the intestines may also result in absorption problems; reduced length or surface area of the intestines available for fluid and nutrient absorption can result in malabsorption. Radiation therapy may injure the mucosal lining of the intestine, resulting in diarrhoea that may not become evident until several years later. The use of some antibiotics can also affect the bacteria that normally live in the intestines and affect intestinal function. Use of certain drugs, such as mineral oil or other laxatives.
Several disorders can lead to malabsorption syndrome, including cystic fibrosis, chronic pancreatitis, lactose intolerance, and glutten enteropathy ( non-tropical sprue). Celiac Disease ( sprue, glutten-sensitive enteropathy) is a condition where the mucosal lining of the small intestine is damaged by ingestion of gluten. Gluten is a protein found in wheat, rye, barley and oats but not in corn or rice. Maintaining a gluten-free diet restores the damaged mucosal lining to normal and restores normal absorption. On occasion patients may fail to respond to a gluten-free diet. These patients can have refractory sprue or intestinal lymphoma. Prednisone ( steroids) helps in up to 50 per cent of patients with refractory disease.
Crohn’s Disease is an inflammatory or ulcerating condition of the GI tract that may affect the small intestine, resulting in malabsorption syndrome. If treated properly, absorption can be restored ( for more information see Crohn’s disease).
Tropical sprue is a bacterial mediated disease causing a similar picture to that of Celiac Disease. Treatment consists of antibiotics, especially Tetracycline, for up to 6 months.
Whipples disease is a systemic bacterial illness usually affecting middle-aged men and presents with diarrhoea, arthritis, fever, weight loss, swollen lymph nodes and skin pigmentation. It is diagnosed by taking a small bowel biopsy through an endoscope. The treatment is administration of antibiotics for one year or longer.
Lactase deficiency can result in malabsorption. Often, one can have partial lactase deficiency that causes symptoms but not full-blown malabsorption. The treatment is to avoid lactose – containing dairy products ( milk, ice-cream, cheese and so on), and lactase enzymes supplements to aid in digestion.
Parasitic diseases can cause selective malabsorption of lactose or fat. Giardia lamblia is the most common of these parasites and is contracted by ingesting unpurified water. It is treated with drugs like metronidazole or ornidazole.
Other causes of malabsorption can be due to past intestinal surgeries, bacterial overgrowth, AIDS, radiation to the abdomen, diabetes, lymphoma or motility disorders. Malabsoption can occur in those who have had portions of their stomachs removed surgically. The pancreas produce enzymes that help to digest food. Therefore, if a condition exists where enzymes are not being produced it can result in maldigestion or malabsorption. This could include chronic alcoholic pancreatitis, cystic fibrosis, tumours or post surgical states.