Symptoms, Diagnosis and Treatment
The most common symptoms of malabsorption syndrome are diarrhoea, bloating, flatulence, cramping and weight loss. Over time, deficiency of iron, proteins, various vitamins and minerals can occur.
This can lead to degrees of malnutrition and a variety of anaemias, the most common being those of vitamin B 12, folate, and iron deficiency. Vitamin K malabsorption could result in excess bleeding.
Protein depletion can lead to impaired bone formation and osteoporosis, and calcium deficiency can cause weakening and demineralization of the bones, causing a condition called osteomalacia.
Impaired absorption of vitamin A could result in night blindness and dermatitis. Irregular heart rhythms may result from inadequate levels of potassium and other electrolytes.
Children with malabsorption syndrome often exhibit a failure to grow and thrive.
There may also be signs of nutrient, vitamin, and mineral depletion: fissures at the corners of the mouth; fatigue or weakness; dry hair; easy bruising; tingling in fingers or toes; and numbness or burning sensation in legs or feet.
Diagnosis is based on proving the existence of steatorrhoea, that is, the passage of fat > 6 g/24 hr stools. A 72-hour stool collection is required for faecal fat measurement.
Increased faecal fat in the stool indicates malabsorption.
The next step after proving steatorrhoea isw to differentiate between absorptive abnormality and digestive abnormality.
This is done by the D-xylose test. D-xylose is a sugar that does not need to be digested to be absorbed; it is excreted in the urine. Low urinary excretion of D-xylose suggests an absorptive abnormality.
This can be due to bacterial overgrowth, which is confirmed by breath test or due to a diffuse lesion of the jejunum which is confirmed by jujenal biopsy.
Ultrasound, CT Scan, MRI, barium enema, or other rays to identify abnormalities of the gastrointestinal tract and pancreas may also be required.
Fluid and nutrient replacement is essential for any individual with malabsorption syndrome. Consultation with a dietitian to assist with nutritional support and meal planning is helpful.
The patient should be encouraged to eat small, frequent meals throughout the day and avoiding fluids and foods that promote diarrhoea. In some cases, fluid volume excess occurs as a result of diminished protein in the blood.
In such cases fluid intake restriction is advised.
Some patients may require injections of vitamin B12 and oral iron supplements. Supplements of enzymes are required to replace missing intestinal enzymes.
People with cystic fibrosis and chronic pancreatitis require pancreatic supplements. Antispasmodic drugs are used to reduce abdominal cramping and associated diarrhoea. Those with lactose intolerance or glutten enteropathy ( non-tropical sprue) will have to modify their diets to avoid foods that they cannot digest properly.