Malabsorption

Causes

Many diseases or conditions that affect the intestines can cause malabsorption, including:

• Lactose intolerance
• Celiac disease
• Intestinal parasites
• AIDs, cancer, or treatment for those diseases
• Whipple’s disease or other bacterial infections
• Crohn’s disease
• Inadequate digestion due to:
  • Gastric resection (removal of all or part of the stomach)
  • Inadequate function of the pancreas (eg, cystic fibrosis, pancreatitis)
  • Excessive production of gastric acid
  • Short bowel syndrome or previous bowel resection

Risk Factors

The following factors increase your chance of developing malabsorption. If you have any of these risk factors, tell your doctor:

• Medical conditions affecting the intestine, such as celiac disease, cystic fibrosis, or Crohn’s disease
• Use of laxatives
• Excessive use of antibiotics
• Intestinal surgery
• Excessive use of alcohol
• Travel to countries with high incidence of intestinal parasites

Symptoms

If you experience any of these symptoms, do not assume it is due to malabsorption. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.

• Weight loss
• Abdominal distention and bloating
• Diarrhea
• Flatulence
• Bulky, foul-smelling stools
• Weakness and fatigue
• Swelling or fluid retention
• Muscle wasting

Diagnosis

Your doctor will ask about your symptoms and medical history and perform a physical exam. Your primary care physician may refer you to a gastroenterologist.

Tests may include the following:

• Blood draw—This tests for low levels of vitamins, minerals, and other nutrients.
• X-rays (with contrast material)—The small bowel and pancreas are examined.
• Small bowel biopsy —A sample of tissue is taken in the small intestine and examined under a microscope.
• A 72-hour stool collection—For this test, you are given a high fat diet, and your stools are collected for 1-3 days and tested for excess fat.
• Pancreatic function test—For this test, you are given a dose of a chemical called bentiromide, which is normally broken down into another chemical called PABA by the pancreas. PABA then gets absorbed and makes its way into the urine; a urine test showing low levels of PABA suggests a problem with the pancreas.
• D-Xylose absorption test—For this test, you are given a sugary solution called D-xylose to drink, after which samples of your blood and urine are collected over several hours; low xylose levels indicate an abnormality in intestinal absorption.
• Hydrogen breath test—This test measures how well lactose is being digested.

Treatment

The specific underlying condition must be treated in order to reverse the malabsorption. Talk with your doctor about the best treatment plan for you.

Depending on the cause and severity of the malabsorption, you may need to make up for nutritional deficiencies by consuming additional nutrients through foods or supplements. A diet rich in vitamins and minerals along with increased quantities of fat, protein, or carbohydrate may be required. Nutrient supplementation may include folate, iron, and injections of vitamin B12. In some cases, such as with severe diarrhea, nutrients may be given intravenously while you are rehydrated.

Prevention

To help reduce your chances of getting malabsorption, take the following steps:

• Minimize use of certain medicines, such as antibiotics, that can adversely affect the function of the intestines.
• Do not drink too much alcohol.
• When traveling to foreign countries with questionable water supply, consume only bottled water, eat only cooked foods, and avoid fresh salads or other washed produce.
• Limit or avoid use of laxatives.