Malabsorption

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Malabsorption is a broad term used to describe the inability to absorb nutrients through the gut lining and into the rest of the body. Malabsorption is not a disease by itself, but rather the result of some other condition that is present. The small intestine (also called the small bowel) is typically involved in malabsorption, since the majority of nutrients are absorbed there. Malabsorption may affect one or more of the many nutrients present in the diet, including large molecules such as protein, fat, and carbohydrates, as well as smaller substances, such as vitamins or minerals.

What are the symptoms of malabsorption? People with malabsorption may have symptoms of frequent, loose, watery stools; pale, foul-smelling, bulky stools; abdominal pain, gas, and bloating; weight loss; fatigue; canker sores; muscle cramps; delayed growth or short stature; bone and joint pain; seizures; painful skin rash; night blindness; easy bruising; and infertility. In addition to physical symptoms, there may be emotional disturbances, including feelings of anxiety and depression.

How is it treated? The conventional treatment is directed at any underlying medical condition (e.g., celiac disease, tropical sprue, Whipple’s disease, pancreatic insufficiency, and short bowel syndrome). People with severe damage to the absorptive surface of their intestines may also be prescribed intravenous nutritional supplements. Immunosuppressive and anti-inflammatory medications, such as glucocorticoids and 6-mercaptopurine, are sometimes used as components of conventional treatment.

What causes malabsorption? There are over 100 different conditions that can lead to problems in absorbing food, most of which are rare. The degree of malabsorption depends on the type of underlying condition and the extent to which it has affected the gut. Some of the more common malabsorption syndromes are due to bacterial or parasitic infections, Crohn’s disease, celiac disease, ulcerative colitis, liver disease (including cirrhosis, hepatitis, and gallstones), cystic fibrosis, lactose intolerance, chronic pancreatitis, specific medications that affect the intestines, or surgery of the stomach or bowels. The four conditions that most often lead to malabsorption in the United States are lactose intolerance, celiac disease, Crohn’s disease, and chronic pancreatitis.1

Malabsorption may also occur when certain minerals present in the digestive tract in large amounts prevent adequate absorption of other minerals that are present in relatively small amounts. Minerals that may have this type of interaction include calcium, copper, iron, magnesium, manganese, and zinc.

What does not cause malabsorption? Some popular health regimens claim that certain dietary practices, such as eating only raw food or avoiding certain food combinations, will prevent malabsorption of nutrients. There is no evidence to support these claims.

How is malabsorption treated? Treatment of malabsorption will vary depending on the diagnosis. Please see articles on specific conditions for more information.

References:

1. Cotran RS, Kumar V, Robbins SL. Robbins Pathologic Basis of Disease, 5th ed. Philadelphia: WB Saunders, 1994, 796–806.