The Cause, Effect And Treatment Of Malabsorption Syndrome Sample

Malabsorption syndromes are a group of conditions in which the bowels are not able to absorb one or more of the essential nutrients (such as minerals, vitamins, proteins, fats, carbohydrates, etc.) [1]. The person may develop a range of symptoms and signs arising from this condition. The malabsorption may be general or specific [2].

There may be several causes and factors that can lead to the development and progression of malabsorption syndrome. The proteins, carbohydrates, fats, and vitamins are absorbed through the mucous membrane of the small intestines. The actual process of digestion begins in the mouth and is continued through the esophagus and the stomach. Once the food reaches the small intestines, it is partially digested in the form of a bolus and is absorbed by the mucous membrane of the small intestines [3]. The entire process of digestion has three stages, namely the luminal stage, mucosal stage, and the removal stage.

In the luminal stage, the nutrients present in the partially digested food are hydrolyzed and made more soluble using enzymes and substances emitted by the liver and the pancreas. In the mucosal stage, the epithelial cells present in the mucous membrane of the small intestines absorb some of these nutrients and process them to be dispatched to other parts of the body. In the removal stage, the nutrients enter the blood or the lymph to be sent to various parts of the body. Malabsorption syndrome implies that a defect or a disturbance (from congenital or acquired reasons) develops in any of these three stages [4]. A defect may develop in the digestive process resulting in the failure of the body to digest the food.

The digestive enzymes may not be produced or certain congenital or acquired structural defects may impact the structures of the digestive system (such as the liver, gallbladder, pancreas, etc.). Also, several infectious diseases and inflammatory conditions in the body can also bring about malabsorption. There may also be disorders in the transit in the enteric mucous membrane that would impact the absorption of the nutrients and lead to malabsorption syndrome [5].

Some of the conditions in which malabsorption syndrome can develop include pancreatic disorders (such as pancreatitis, Shwachman-Diamond syndrome, chronic alcoholism, cystic fibrosis, and carcinoma of pancreas), bile deficiency (such as removal of the terminal ileum, obstruction of the enterohepatic circulation, etc.), uncoordinated emptying of the contents of the stomach (such as in gastrectomy and gastroenterostomy), generalized mucosal disorders (such as celiac disease, tropical sprue, lymphoma, radiation enteritis, giardiasis, abetalipoproteinemia, agammaglobulinemia, radiation enteritis, ulcerative jejunitis, short intestine syndrome, bacterial overgrowth, Whipple’s disease, etc.), malabsorption of certain substances (such as lactase deficiency), impaired fat absorption (such as gastrinoma and colipase deficiency), abnormal micelle formation (such as chronic liver disease, bacterial overgrowth, cholestatic disease of the liver, Crohn’s disease and ileal removal), unknown mechanisms (such as in adrenal insufficiency, thyrotoxicosis, and carcinoid syndrome), etc. [6] [7].

When a person undergoes surgery affecting the removal of the stomach and the jejunum, the bilious and pancreatic secretions are released into the small bowels off from the normal site of entry (that is the jejunum). The fats may not be broken down properly. Also, the micelle formation may also become abnormal (as the gall salts production or supply to the lms is reduced), leading to malabsorption of fats. The food may pass through the jejunum at a very fast rate, leading to malabsorption [8].

In several disorders affecting the pancreas, lipase secretion may be reduced, leading to malabsorption of fats. In certain disorders of the small bowels, the enzymes responsible for digestion may be absent, or substances that help in the transit of foods and intermediary substances may be deficient. The nutrients may not be absorbed into the small bowels as the mucous membrane may be damaged, involved with certain systemic diseases, or surgically treated. The specific nutrients not absorbed depend on the part of the bowel that has been involved [9].

There may be several risk factors for the development of malabsorption syndrome, including a family history of malabsorption, administration of certain medicines (such as laxatives), surgery performed on the stomach and the bowels, alcohol addiction, etc [10]. Persons who have visited tropical countries are also at a higher risk of developing malabsorption due to the development of protozoan infections of the small bowels [11].

Persons with malabsorption can develop a number of symptoms and signs. The symptoms and signs that may develop depend on the specific type of malabsorption syndrome present. Some of the common symptoms that may develop include anemia (due to a lack of vitamin B12, folic acid, or iron required to produce RBCs), diarrhea, steatorrhea (presence of fat in the stools), abdominal spasms, bloating, excessive gas production, abdominal distention, abdominal discomfort, foul-smelling stools, etc. The person may also develop several generalized symptoms such as skin rashes, itching, muscle wasting, edema, growth retardation, fatigue, loss of body weight, problems in healing of the lesions, shortness of breath, etc.

The person may develop fat, carbohydrate, protein, vitamin, and/or mineral deficiencies. If the protein absorption is low, fluids tend to accumulate in various parts of the body, leading to edema. In carbohydrate and fat malabsorption, diarrhea, abdominal spasms, weight loss, growth retardation, and excessive production of gas occurs. In malabsorption of electrolytes, diarrhea, shock, dehydration, and cardiac abnormality develop. In iron malabsorption, anemia, angular cheilitis, weakness, shortness of breath, and tiredness develop.

In calcium and vitamin D malabsorption, bone pain, fractures, tetany, defects in nerve signal conductivity, etc. develop. In vitamin B-complex deficiency, anemia, angular cheilitis, glossitis, cheilitis, beri beri, skin problems, etc may develop. In vitamin A deficiency, night blindness develops, and in vitamin K deficiency, ecchymosis can occur. Persons with vitamin E malabsorption may develop paresthesia and ataxia [12]. Despite the individual consuming a normal amount of food in the diet, a deficiency may occur, and the person may experience weight loss. Some individuals may develop vague symptoms.

The diagnosis of malabsorption syndrome is made based on the individual’s history, symptoms, physical examination, blood tests, urine tests, stool examination, imaging tests, biochemical tests, endoscopy studies, breath tests, biopsy of the small bowels, D-xylose test, Schilling’s test, liver function tests, pancreatic function tests, and other tests. A detailed medical and family history is taken from the individual. The medical history is taken to determine past GI surgeries, GI disorders, radiation therapy, etc. [13]. A detailed family history is taken to identify the presence of celiac disease, Crohn’s disease, cystic fibrosis, lactase deficiency, etc. in the family [14]. A thorough physical examination is performed to determine the physical symptoms present, such as skin rashes, abdominal discomfort, etc. [15].

The doctor also studies the mental functions, as some of the malabsorption conditions may also affect the operation of the brain. Stool examination is performed to determine the amount of stools emitted every day, microbiology, fat content, etc. The presence of D-xylose usually suggests malabsorption [16]. Blood tests are utilized to determine the levels of certain substances in the blood. Various imaging techniques such as X-rays, ultrasound, MRI scans, and CT scans are performed to examine any abnormality of the organs of the digestive tract [17]. Breath tests are required to determine the presence of microorganisms in the digestive tract [18]. Several specific malabsorption syndromes may require the use of biopsy of certain specific structures to confirm the diagnosis [19]. Schilling’s test may be required to confirm the diagnosis of Vitamin B-12 deficiency [20].

Individuals with malabsorption syndrome should be closely assessed with the type of deficiency they are suffering from, and efforts should be made to replace the substances in the body that are lacking to ensure that critical functions are not affected. Electrolytes should be replaced immediately, as a deficiency could seriously affect the operation of the heart. If the individual lacks carbohydrates, immediate provision of dextrose through an intravenous line may be necessary. Some individuals with severe forms of malnutrition may require hospitalization to manage glucose and electrolyte deficiency [21].

After the acute complications are handled, the cause of the malabsorption syndrome should be managed appropriately, and a diet chart should be prepared in consultation with a nutritionist [22]. The cause of malabsorption should be addressed properly. Infectious diseases should be treated by administering the appropriate antimicrobial agents. Enzymes that are not produced by the body should be replaced. Substances that the body cannot metabolize may have to be administered regularly through parenteral or oral means [23].

Individuals who tend to repeatedly develop abdominal spasms and discomfort may have to be given antispasmodic agents [24]. In some cases, individual vitamin and mineral deficiencies may have to be corrected by administering supplements. The individual should also consume a nutritious diet containing appropriate amounts of all nutrients. Some individuals may have to modify their diet to avoid certain substances (such as lactose or gluten) as they may be unable to digest these substances [25].

Mentions:

1. Lehrer, J. K. (2006). Malabsorption. [Online]. Available: http://www.nlm.nih.gov/medlineplus/ency/article/000299.htm. [Accessed: 2007, April 15].
2. OME – WGO Practice Guideline: Malabsorption. [Online]. Available: http://www.omge.org/globalguidelines/guide03/g_data3_en.php. [Accessed: 2007, April 15].
3. Ramakrishna, B. S., Venkataraman, S., and Mukhopadhya, A. (2006). “Tropical malabsorption” Postgrad Med J. vol. 82, no. 974, December, pp. 779-87. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=17148698&A;=dopt=Abstract.
4. Semrad, C. E., and Chang, E. B. (2000). Malabsorption Syndromes. In: Goldman, L. and Bennett, J. C. (eds). Cecil Textbook of Medicine. 21st ed. W. B. Saunders Company, Philadelphia, pp. 712-722.
5. Shearman, D. J. C. (1996). Diseases of the Alimentary Tract and Pancreas. In: Edwards, C. R. W., Bouchier, I. A. D., and Haslett, C. (eds). Davidson’s Principles and Practice of Medicine. 17th ed. Churchill Livingstone, Edinburgh, pp. 447.
6. The Merck Manual (2003). Malabsorption-Introduction. [Online]. Available: http://www.merck.com/mmhe/sec09/ch125/ch125a.html. [Accessed: 2007, April 15].
7. Wright, K. D. (1999). Malabsorption Syndrome. [Online]. Available: http://healthresources.caremark.com/topic/topic100587120. [Accessed: 2007, April 15].
8. Shearman, D. J. C. (1996). Diseases of the Alimentary Tract and Pancreas. In: Edwards, C. R. W., Bouchier, I. A. D., and Haslett, C. (eds). Davidson’s Principles and Practice of Medicine. 17th ed. Churchill Livingstone, Edinburgh, pp. 447.
9. Lehrer, J. K. (2006). Malabsorption. [Online]. Available: http://www.nlm.nih.gov/medlineplus/ency/article/000299.htm. [Accessed: 2007, April 15].
10. Wright, K. D. (1999). Malabsorption Syndrome. [Online]. Available: http://healthresources.caremark.com/topic/topic100587120. [Accessed: 2007, April 15].
11. OME – WGO Practice Guideline: Malabsorption. [Online]. Available: http://www.omge.org/globalguidelines/guide03/g_data3_en.php. [Accessed: 2007, April 15].
12. Wright, K. D. (1999). Malabsorption Syndrome. [Online]. Available: http://healthresources.caremark.com/topic/topic100587120. [Accessed: 2007, April 15].
13. Shearman, D. J. C. (1996). Diseases of the alimentary tract and pancreas. In: Edwards, C. R. W., Bouchier, I. A. D., and Haslett, C. (Eds.). Davidson’s Principles and Practice of Medicine (17th ed.). Churchill Livingstone, Edinburgh, pp. 447.
14. Semrad, C. E., and Chang, E. B. (2000). Malabsorption Syndromes. In: Goldman, L., and Bennett, J. C. (Eds.). Cecil Textbook of Medicine (21st ed.). W. B. Saunders Company, Philadelphia, pp. 712-722.
15. Semrad, C. E., and Chang, E. B. (2000). Malabsorption Syndromes. In: Goldman, L., and Bennett, J. C. (Eds.). Cecil Textbook of Medicine (21st ed.). W. B. Saunders Company, Philadelphia, pp. 712-722.
16. Ibid.
17. Wright, K. D. (1999). Malabsorption Syndrome. [Online]. Available: http://healthresources.caremark.com/topic/topic100587120. [Accessed: 2007, April 15].
18. Ramakrishna, B. S., Venkataraman, S., and Mukhopadhya, A. (2006). “Tropical malabsorption.” Postgrad Med J, vol. 82, no. 974, December, pp. 779-87.
19. Semrad, C. E., and Chang, E. B. (2000). Malabsorption Syndromes. In: Goldman, L., and Bennett, J. C. (Eds.). Cecil Textbook of Medicine (21st ed.). W. B. Saunders Company, Philadelphia, pp. 712-722.
20. Semrad, C. E., and Chang, E. B. (2000). Malabsorption Syndromes. In: Goldman, L., and Bennett, J. C. (Eds.). Cecil Textbook of Medicine (21st ed.). W. B. Saunders Company, Philadelphia, pp. 712-722.
21. OME – WGO Practice Guideline: Malabsorption. [Online]. Available: http://www.omge.org/globalguidelines/guide03/g_data3_en.php. [Accessed: 2007, April 15].
22. Semrad, C. E., and Chang, E. B. (2000). Malabsorption Syndromes. In: Goldman, L., and Bennett, J. C. (Eds.). Cecil Textbook of Medicine (21st ed.). W. B. Saunders Company, Philadelphia, pp. 712-722.
23. Wright, K. D. (1999). Malabsorption Syndrome. [Online]. Available: http://healthresources.caremark.com/topic/topic100587120. [Accessed: 2007, April 15].
24. OME – WGO Practice Guideline: Malabsorption. [Online]. Available: http://www.omge.org/globalguidelines/guide03/g_data3_en.php. [Accessed: 2007, April 15].
25. OME – WGO Practice Guideline: Malabsorption. [Online]. Available: http://www.omge.org/globalguidelines/guide03/g_data3_en.php. [Accessed: 2007, April 15].
26. Shearman, D. J. C. (1996). Diseases of the alimentary tract and pancreas. In Edwards, C. R. W., Bouchier, I. A. D., and Haslett, C. (Eds.), Davidson’s Principles and Practice of Medicine (17th ed., pp. 447). Churchill Livingstone: Edinburgh.
27. Wright, K. D. (1999). Malabsorption Syndrome. [Online]. Available: http://healthresources.caremark.com/topic/topic100587120. [Accessed: April 15, 2007].
28. Wright, K. D. (1999). Malabsorption Syndrome. [Online]. Available: http://healthresources.caremark.com/topic/topic100587120. [Accessed: April 15, 2007].
29. Ibid.
30. Ibid.
31. Ibid.
32. Ibid.