In malabsorption syndrome, the patient’s intestines do not adequately absorb certain or all nutrients from food into the bloodstream, resulting in nutrient deficiency. Malabsorption characterizes many congenital intestinal diseases and intolerances to certain foods. In addition to dietary measures and treatment of the underlying disease, malabsorption syndrome usually involves substitution of nutrients by infusion.
What is malabsorption syndrome?
Nutrients are absorbed from food in the intestine, that is, they are absorbed into the bloodstream. Absorption is a vital process that provides the body with irreplaceable substances. Therefore, impaired absorption of nutrients from the intestine can have far-reaching consequences that can negatively affect the body’s health in many ways. Absorption disorders in the intestinal tract are summarized under the term malabsorption syndrome. The individual disorders form a wide spectrum of different symptoms, all of which can be caused by impaired substrate absorption from the intestine. The resulting deficiencies in the respective insufficiently absorbed substance manifest themselves in entirely different clinical pictures. The criterion for the classification of the individual diseases into the disease group malabsorption syndrome is exclusively the cause. Besides intestinal diseases such as Crohn’s disease, all sensitivity disorders are among the best-known malabsorption syndromes. Maldigestion must be distinguished from malabsorption. In this phenomenon, the cleavage of food components in the stomach is disturbed, which is usually caused by an enzyme defect or enzyme deficiency.
Causes
Malabsorption is caused by a chronic diseased condition of the intestine. In malabsorption syndrome, the food that has already been broken down and thus predigested cannot release its nutrients through the intestinal wall into the lymphatic and blood systems, or can do so only inadequately. This is the case, for example, in numerous congenital diseases, which are usually based on a mutation of certain intestinal building blocks. In addition, chronic inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease can damage the intestine in the long term, so that its elements can no longer easily perform the task of absorption. Hypersensitivity diseases such as celiac disease are also associated with malabsorption syndrome. The same applies to infections such as Whipple’s disease. In certain cases, the syndrome may also develop from postoperative conditions, such as those resulting from extensive small bowel resection. All diseases with the symptom of malabsorption are called malabsorption syndromes. A causal distinction is made with the subgroups congenital and acquired malabsorption syndromes.
Symptoms, complaints, and signs
Patients with malabsorption syndrome primarily present with mass stools weighing more than 300 grams as leading symptoms. Foul-smelling fatty stools, also known as steatorrhea, are common. Patients also suffer from flatulence and thus excessive gas development, which can manifest itself in the form of flatulence or a painful bloated abdomen. Often, malabsorption is accompanied by more or less severe weight loss. Affected individuals develop certain deficiency states due to inadequately absorbed nutrients. Typically, there is an undersupply of vitamins. Folic acid and minerals such as calcium and iron may also be associated with the deficiency. The same is true for protein and trace elements. Muscle weakness and skin and mucous membrane changes occur as a result of the deficiency. In most cases, patients also suffer from anemia. All other symptoms depend on the causative disease in each individual case. In bariatric surgery, malabsorption is therapeutically induced to combat morbid obesity by manipulating the digestive tract in surgical procedures. This case also results in lifelong deficiency states that require medical monitoring and treatment.
Diagnosis and course of the disease
The first suspicion of malabsorption syndrome is developed by the physician during the history taking. For example, if the patient complains of facial wasting that occurs despite adequate caloric intake and there are no other medical conditions, malabsorption is an obvious conclusion.Finally, the physician assesses the quality of the digestive processes by requesting a bowel movement from the patient. The color, firmness, texture and quantity of the stool can confirm the suspected diagnosis and provide important clues as to the cause of the disease. Sonography, various blood tests and endoscopy can be used to further confirm the diagnosis. The prognosis depends on the type of malabsorption syndrome.
Complications
Due to malabsorption syndrome, affected individuals suffer from reactive greasy and very heavy stools. Likewise, flatulence and a bloated abdomen occur, so that the quality of life of patients is significantly reduced by these complaints. It is not uncommon for this syndrome to lead to weight loss and a reduced supply of vitamins and other minerals. The undersupply has a very negative effect on the patient’s health and can lead to various complaints and complications. It is not uncommon for those affected to also suffer from anemia and, as a result, fatigue and lassitude. Treatment of malabsorption syndrome can be relatively simple with the help of a suitable diet. Sufferers are mainly dependent on low-fat meals. This can limit most of the symptoms relatively well. Complications do not occur in most cases. If there is an undersupply of trace elements, this undersupply must be compensated. Various supplements are used for this purpose. In many cases, those affected are dependent on the supplements for the rest of their lives. However, life expectancy is not limited or reduced with proper treatment.
When should you see a doctor?
People who suffer from intolerances to various foods should have a medical examination. If the number of foods increases and discomfort occurs immediately after their intake, consultation with a doctor is necessary. If flatulence, digestive disorders or fatty stools occur, a doctor should be consulted. Pain in the abdomen, a feeling of fullness and an increase in abdominal girth should be clarified by a doctor. If the usual performance level drops, a reduction in muscle strength sets in or signs of a deficiency appear, a doctor is needed. An untraceable weight loss and a pallor of the skin are further indications of an existing health impairment. A visit to the doctor is advisable so that a diagnosis can be made and a treatment plan drawn up. Changes in the appearance of the skin as well as abnormalities of the mucous membranes in the mouth or throat should be presented to a doctor. Cold hands and feet are often signs of a circulatory disorder or a present anemia. A doctor should be consulted if there is no improvement in the body’s thermoregulation over a longer period of time. If sleep disturbances occur or there are peculiarities in the behavior, the affected person needs help. Therefore, in case of withdrawal from social life or mood swings, a visit to the doctor is recommended.
Treatment and therapy
An important issue in the treatment of malabsorption syndromes is diet. The patient must adjust his or her diet to the cause of the underlying condition. For example, in the case of intolerances, he henceforth abstains from the intolerant food. Since low-fat meats such as chicken, steamed fruits and four-course cooked vegetables are particularly easy to digest, these foods are often on the menu of those affected. Secondary deficiency symptoms caused by dietary measures must be excluded as far as possible. Disturbances of the water and electrolyte balance are usually countered in medicine by means of infusions. By administering them directly into the bloodstream, the intestine is bypassed and an existing deficiency of certain substances can be compensated. Vitamin deficiencies, mineral deficiencies and trace element deficiencies can also be countered with injections. In addition to this symptomatic treatment, therapy of the underlying disease takes place as far as possible. If the intestine’s ability to absorb nutrients remains intact, nutritional supplementation can already compensate for nutrient deficiencies. Substitution by dietary supplementation takes place, for example, in the case of obese patients in whom malabsorption has been deliberately induced.Depending on the underlying disease, the substitution requirement may last a lifetime.
Outlook and prognosis
There is no single prognosis for malabsorption syndrome. It involves a variety of intestinal disorders, some congenital and some acquired. These are characterized by disorders of absorption of specific nutrients that vary in cause and severity. In this respect, malabsorption syndromes pose a threat to general health. In some cases, the patient can receive the unabsorbed nutrients via infusions or tablets. In some cases, a special diet or therapy tailored to the malabsorption may help. Most importantly, it must first be determined what form of malabsorption syndrome is present in the first place. Without this, a prognosis is not possible. Depending on whether micro- or macronutrients are affected by the malabsorption, the patient has a different quality of life. Malabsorption syndrome may affect only one nutrient, as in pernicious anemia. However, the organism may also become dangerously imbalanced due to the deficient absorption of all nutrients, as in celiac disease. The prognosis for a malabsorption syndrome depends on how serious the disorder is, how early it is detected and what consequences it has for the organism. In many cases, the prognosis is quite good thanks to sufficient treatment options. One of the exceptions, for example, is in the case of congenital or surgically induced short bowel syndrome, where large parts of the small intestine are missing.
Prevention
Malabsorption in the context of hereditary diseases cannot be actively prevented.
Aftercare
The aftercare of gastrointestinal diseases such as malabsorption syndrome depends primarily on the severity of the disease. The patient should decide this individually with his or her treating physician. Due to malabsorption syndrome, the affected person can suffer from various complications. However, these depend very much on the exact manifestation of the syndrome, so that a general prediction about the further course cannot be made. Most patients suffer from greasy bowel movements. Flatulence, constipation and diarrhea occur. Many patients react to the state of emergency with depressive symptoms or other psychological upsets. Part of the aftercare therefore focuses on restoring emotional stability and a safe way of dealing with the situation. If malabsorption syndrome causes weight loss, which may be accompanied by deficiency symptoms, the extent to which nutritional substitution should be undertaken should be discussed with the physician. Each patient should also discuss with his or her family doctor whether a general change in diet is appropriate. Many of those affected not infrequently suffer from inferiority complexes or a significantly reduced sense of self-worth and do not dare to see a doctor because of their complaints. If the complaints occur permanently, the syndrome can damage the internal organs. This damage often becomes irreparable, so that it can even lead to a reduced life expectancy of the patient.
What you can do yourself
Malabsorption syndrome is a collective term that encompasses many different gastrointestinal disorders. Therefore, the measures that patients can do themselves are based on the particular cause. However, it should also be noted that many malabsorption disorders can only be treated by a physician. First, it is necessary to have the underlying condition diagnosed. Possible causes include celiac disease, fructose intolerance, lactose intolerance, liver and gallbladder diseases, chronic intestinal inflammation (Crohn’s disease), chronic pancreatitis or stomach diseases. In the case of celiac disease, the patient must eat a gluten-free diet for life. The diet should also be adapted in the case of fructose intolerance. Since the personal tolerated dose of fructose varies here, the affected person can test for himself how much fruit he can still tolerate after a diet low in fructose and fiber. However, sweet drinks and sugar should be avoided. In the case of lactose intolerance, gastrointestinal disorders can be reduced by a low-lactose diet. Liver and bile diseases often require a change to a low-fat diet. However, if there is cirrhosis of the liver, the diet must also be low in protein.The patients with chronic pancreatitis are strongly recommended to avoid smoking and alcohol. Several small meals should be taken, which contain sufficient calories, vitamins and nutrients. In case of gastric disorders, the patient can also try out what he can tolerate. In any case, spicy foods, alcohol or caffeine should be avoided.
