Malabsorption syndrome: what is behind the medical term? Malabsorption: syndrome clinic, diagnosis and treatment methods Malabsorption and chronic low back pain

• Classification of malabsorption syndrome

  Malabsorption syndrome reflects the state of the digestive-transport function of the small intestine.

  In terms of severity, malabsorption syndrome can be mild, moderate or severe.

  • I degree of severity.

    In patients, body weight decreases (by no more than 5–10 kg), working capacity is reduced; worries about general weakness; there are signs of multivitamin deficiency.

  • II degree of severity.

    Patients have a significant deficiency of body weight (in 50% of cases more than 10 kg), pronounced signs of multivitamin deficiency and electrolyte deficiency (potassium, calcium); anemia, hypofunction of the gonads.

  • III degree of severity.

    In most patients, the body weight deficit can exceed 10 kg. All patients have pronounced signs of multivitamin deficiency and electrolyte deficiency (potassium, calcium, iron); there may be convulsions, osteoporosis, anemia, edema; dysfunction of the endocrine system.

  Malabsorption syndrome can be congenital or acquired:

  • Congenital Malabsorption Syndrome.

    Occurs in 10% of cases. As a rule, these are patients with celiac disease, cystic fibrosis, Shwachman-Diamond syndrome, disaccharidase deficiency, lactase, sucrase and isomaltase deficiency; cystinuria (a hereditary disease characterized by a violation of the transport of a number of amino acids in the epithelial cells of the intestinal tract), Hartnup's disease (tryptophan malabsorption as a result of a violation of the transport function of intestinal mucosal cells).

  • Acquired malabsorption syndrome.

    This variant of the syndrome is observed in patients with enteritis, Whipple's disease, intestinal lymphangiectasia, tropical sprue, short bowel syndrome, malignant tumors of the small intestine, chronic pancreatitis, liver cirrhosis. In 3% of patients with acquired malabsorption syndrome, an allergy to cow's milk protein is found.

• Epidemiology of malabsorption syndrome

  Congenital malabsorption syndrome occurs in 10% of cases (in patients with celiac disease, cystic fibrosis).

  In addition, the cause of congenital malabsorption syndrome can be a congenital deficiency of sucrase and isomaltase, which is observed in the indigenous inhabitants of Greenland and the Eskimos of Canada. Cases of congenital deficiency of trielase (a sugar found in mushrooms) have also been reported among the indigenous people of Greenland. Congenital lactase deficiency, which manifests itself clinically in adulthood, is diagnosed in patients from Asia, Africa and the Mediterranean region.

  Symptoms of congenital malabsorption syndrome appear immediately after birth or in the first decade of life. In this group of patients, the highest mortality rates from malabsorption syndrome (due to exhaustion) are observed among young children. In general, the survival of patients with congenital malabsorption syndrome is determined by the underlying disease that led to the development of the syndrome.

  The prevalence of acquired malabsorption syndrome depends on the prevalence of those diseases that cause its development.

• Etiology and pathogenesis of malabsorption syndrome

  Malabsorption syndrome reflects the state of the digestive-transport function of the small intestine. The process of digestion of food digestion in the small intestine consists of the stages of abdominal and parietal (membrane) digestion. Disorders of the process of digestion of food are manifested by violations of the cavity and membrane (parietal) digestion.

• Malabsorption syndrome clinic

  In the clinical picture of malabsorption syndrome, nonspecific and specific symptoms are distinguished.

  • Nonspecific symptoms in malabsorption syndrome
    • General manifestations.

      Weakness, fatigue, anorexia, bloating, flatulence, rumbling, and abdominal pain are characteristic of malabsorption syndrome, but are not specific.

      • Weakness and fatigue may be associated with electrolyte imbalances, anemia, and hyperphosphatemia.
      • Pain in the upper abdomen, radiating to the lumbar region or girdle, is observed in patients with chronic pancreatitis.
      • Rumbling and cramping abdominal pain are detected in patients with lactase deficiency.
      • Flatulence is caused by an overgrowth of bacteria in the intestines (due to the accumulation of undigested food in the intestines).
      • Peristalsis may be visible to the eye; on palpation of the abdomen, there is a feeling of fullness, "testiness" due to a decrease in the tone of the intestinal wall.
    • Diarrhea.
      • The feces of patients with malabsorption syndrome are offensive.
      • The volume of faeces is increased.
      • The consistency of feces is mushy or watery.
      • The stool can acquire a greasy sheen and become acholic if the patient has impaired synthesis of bile acids or their entry into the intestine is difficult (with cholestasis).
    • Weight loss.

      This symptom is caused by insufficient intake of essential nutrients in the body. Weight loss is most pronounced in patients with celiac disease and Whipple's disease. In addition, in children and adolescents with celiac disease, malabsorption syndrome leads to growth retardation.

      • In patients with malabsorption syndrome I degree of severity, body weight decreases by no more than 5–10 kg.
      • In patients with malabsorption syndrome II degree - more than 10 kg (in 50% of cases).
      • In patients with malabsorption syndrome at grade III, in most patients, the body weight deficit may exceed 10 kg.
    • Steatorrhea.

      With steatorrhea, the feces are light, shiny, with an unpleasant odor and inclusions of fat. Its daily volume is increased. Such a chair is poorly washed off the walls of the toilet after a bowel movement.

    • Changes in the skin and its appendages.

      In patients with malabsorption syndrome, dry skin, hair loss, increased fragility of nails, dermatitis, ecchymosis, glossitis are observed, which is associated with iron and vitamin deficiency (especially C, B 12, folic acid).

  • Specific symptoms of malabsorption syndrome
    • Peripheral edema.

      Edema in malabsorption syndrome appears as a result of hypoproteinemia. They are localized mainly in the region of the legs and feet. In severe cases of the syndrome, ascites occurs, associated with impaired protein absorption, loss of endogenous protein, and hypoalbuminemia.

    • Signs of multivitamin deficiency.

      Vitamin deficiency that occurs with malabsorption syndrome can be accompanied by various manifestations.

      • Signs of hypovitaminosis are manifested by changes in the skin, its appendages, tongue and mucous membranes.
      • Dryness and peeling of the skin, cheilitis, glossitis, stomatitis are found. Age spots may appear on the face, neck, hands, legs and feet.
      • Nails become dull, exfoliate.
      • There is thinning and hair loss.
      • There may be petechial or subcutaneous hemorrhages, increased bleeding of the gums (due to vitamin K deficiency).
      • With vitamin A deficiency, patients develop disorders of twilight vision.
      • Bone pain is common in patients with vitamin D deficiency.
      • Deficiency of vitamins B 1 and E leads to paresthesias and neuropathies.
      • Vitamin B12 deficiency leads to megaloblastic anemia (in patients with Crohn's disease or short bowel syndrome).
    • Mineral metabolism disorders.

      Mineral metabolism is impaired in all patients with malabsorption syndrome.

      • Calcium deficiency can cause paresthesia, cramps, muscle and bone pain. In patients with kypocalcemia and hypomagnesemia, Chvostek's and Trousseau's symptoms become positive.
      • In severe cases of malabsorption syndrome, calcium deficiency (along with vitamin D deficiency) can contribute to osteoporosis of the long bones, spine and pelvis.
      • Due to the increased neuromuscular excitability characteristic of hypokalemia, a symptom of a “muscle roller” is detected; patients are also worried about lethargy, muscle weakness.
      • In patients with a deficiency of zinc, copper and iron, a skin rash develops, iron deficiency anemia develops, and body temperature rises.
    • Endocrine disorders.

      With prolonged and severe malabsorption syndrome, symptoms of polyglandular insufficiency appear.

      • Patients have hypofunction of the gonads: impotence, decreased libido. In women, the menstrual cycle is disturbed, amenorrhea may occur.
      • Malabsorption of calcium can lead to secondary hyperparathyroidism.
    • Patients with malabsorption syndrome have symptoms characteristic of the disease that led to malabsorption.
  • Complications of malabsorption syndrome

    The most common complications of malabsorption syndrome are: anemia (macrocytic and microcytic), malnutrition, reproductive dysfunction.

    Other complications of malabsorption syndrome are determined by the course of the disease that led to the development of the syndrome.

    In most cases, these patients are at risk of developing malignant neoplasms. So, in patients with celiac disease, the likelihood of developing intestinal lymphomas is 6-8% (mainly in people over the age of 50 years). The risk of pancreatic cancer in patients with chronic pancreatitis is 1.5-2%.

    Ulcerative jejunoileitis, hyposplenism, arterial hypotension complicate the course of celiac disease.

    During long-term antibiotic therapy in patients with Whipple's disease, side effects of the drugs used may be recorded. Complications of intestinal lymphangiectasia include: gingivitis, defects in tooth enamel. In some patients with secondary intestinal lymphangiectasia, fibrous narrowing of the lumen of the small intestine may occur.

    Complications of ulcerative colitis are: toxic megacolon, massive bleeding (in 3% of cases), stenosis (in 6-12% of cases); perforation and colon cancer. In patients with Zollinger-Ellison syndrome, ulcers may be complicated by bleeding, perforation, and stenosis.

• Diagnosis of malabsorption syndrome
  • Collection of anamnesis

    Malabsorption syndrome may be suspected in patients with chronic diarrhea, weight loss, and anemia.

    First of all, it is necessary to establish the presence of diseases that can lead to malabsorption syndrome.

    When taking an anamnesis, attention should be paid to the age of onset of the disease. Congenital forms of intestinal lymphangiectasia, for example, are recorded in children (the average age of manifestation of the disease is 11 years). The acquired form of the disease is diagnosed in young people (average age of onset is 22.9 years). Celiac disease manifests itself in childhood (usually at the age of 9-18 months), but there may be a later onset of the disease (in women - in 3-4 decades; in men - in 4-5 decades of life). In addition, with the development of malabsorption syndrome in women with celiac disease, the relationship of the onset of the disease with pregnancy and childbirth is assessed.

    Short bowel syndrome occurs after operations performed on patients with Crohn's disease, volvulus, and intestinal tumors; radiation enteritis; thrombosis and embolism of mesenteric vessels; multiple intestinal fistulas.

    During the history taking, it is important to assess the initial symptoms of the disease. So, in most patients with Whipple's disease, the first stage of the disease manifests itself with symptoms of joint damage. There may be an increase in body temperature. The appearance of malabsorption syndrome is the second stage of Whipple's disease.

    The main initial clinical manifestations of primary intestinal lymphangiectasia are massive, symmetrical, peripheral edema and diarrhea without blood admixture. There is a delay or lag in growth.

  • Laboratory diagnostic methods

• Treatment of malabsorption syndrome
  • Treatment Goals
    • Elimination of symptoms of malabsorption.
    • Normalization of body weight.
    • Treatment of the underlying disease that caused malabsorption syndrome.
    • Prevention and treatment of complications of malabsorption syndrome.
  • Basic principles of treatment of patients with malabsorption syndrome
    • Treatment of the underlying disease - the causes of malabsorption syndrome.
    • Correction of the patient's diet, taking into account the clinical picture.
    • Correction of violations of protein metabolism.
    • Correction of vitamin deficiency.
    • Correction of electrolyte disturbances.
    • Correction of motor disorders of the digestive tract.
    • Treatment of concomitant dysbacteriosis.
    • Carrying out rehydration therapy.
  • Treatment methods for malabsorption syndrome
    • diet therapy

      In patients with hypoproteinemia, enteral nutrition mixtures containing the necessary nutrients, vitamins and trace elements are used. For more complete assimilation, these mixtures are introduced into the stomach through a tube. Specialized products are recommended, which are balanced combinations of nutrients containing soluble forms of milk proteins, skimmed milk powder, dry fat component, easily digestible carbohydrates, essential vitamins, for the prevention of bleeding from esophageal varices, such treatment methods are carried out as: sclerotherapy or esophageal vein ligation, portosystemic shunting followed by liver transplantation.

    • For patients with liver failure, liver transplantation is advisable.

• Prevention of malabsorption syndrome

  Prevention of malabsorption syndrome is reduced to the prevention of the disease that led to its development.

• Prognosis for malabsorption syndrome

  In some cases, malabsorption syndrome is transient and stops during diet therapy. Thus, atrophic changes in the mucous membrane of the small intestine, caused by acute enteritis, or malnutrition, lead to damage to approximately 80% of the suction surface. After elimination of a causally significant factor, the restoration of the mucous membrane of the small intestine occurs within 4-6 days. In some cases, it may take a longer period of time - up to 2 months or more.

  If the malabsorption syndrome progresses, then it can lead to complications and a reduction in the patient's life expectancy due to exhaustion. For example, patients with abetaliporoteinemia (congenital disorders of fat absorption and transport) die at a young age due to heart complications.

  Bacterial overgrowth syndrome can inhibit the adaptive mechanisms of the small intestine and increase the risk of liver disorders.

  The long-term prognosis for malabsorption syndrome depends on the duration of parenteral nutrition, which can be complicated. sepsis and thrombosis of the catheterized vein. The death of the patient can also occur as a result of the development of liver failure. Cholelithiasis is found in 45% of patients. The 4-year survival rate in patients on parenteral nutrition is 70%.

  With parenteral nutrition, the mucosa of the digestive tract does not receive trophic stimulation, which inhibits the restoration of the mucosa. The timing of the transition to enteral nutrition depends on the length of the small intestine, the presence of an ileocecal valve, the preservation of the function of the large intestine, and the intensity of the peristalsis of the digestive tract.

Malabsorption is a whole complex of chronic disorders that accompany the processes of absorption, digestion and transport of nutrients that occur in different parts of the small intestine.

In medical sources, the disease has a number of synonymous names:

• malabsorption syndrome;
• syndrome of impaired intestinal absorption;
• chronic diarrhea syndrome.

Caused by a disorder of the transport and digestive functions of the small intestine and having a large set of clinical manifestations, malabsorption syndrome can be the culprit of a pathological metabolic disorder.

Malabsorption is often congenital. Diagnosed in every tenth case, it manifests itself either immediately after the birth of a child, or during the first decade of his life.

Pathology of an acquired nature, progressing against the background of diseases of the pancreas, liver, and can be observed in patients of any age and gender.

Malabsorption, characterized by a violation of the absorption of almost any nutrient, is called total. If the pathology affects the absorption of only certain components, we are talking about isolated (or partial malabsorption).

Causes of the disease

The culprit for the development of primary malabsorption can be a genetically determined enzymopathy (a pathology caused by a deficiency, complete absence or partial damage to the structure of enzymes responsible for the course of digestive processes), which can lead to:

• fructose intolerance;
• impaired absorption of certain amino acids;
• glucose-galactose intolerance;
• malabsorption of folic acid or vitamin B12.

The occurrence of secondary malabsorption, which is much more common than primary, can occur in patients suffering from:

• Worm infestations.
• Atrophic gastritis is a serious inflammatory process that leads to damage to the mucous membranes of the stomach.
• Pancreatitis - inflammation of the pancreas.
• Autonomic neuropathy is a disease of the nervous system characterized by a complete loss of control over the functioning of the digestive system.
• Diseases leading to damage to the intestinal walls (for example, radiation).
• Celiac enteropathy () - a digestive disorder provoked by damage to the small intestinal villi by a number of foods containing gluten (gluten) and related proteins found in cereals: oats, wheat, barley and rye.
• Hyperthyroidism is a clinical condition characterized by increased hormonal activity of the thyroid gland, secreting an excess amount of thyroid hormones (triiodothyronine and thyroxine).
• Syndrome of increased bacterial growth.
• Whipple's disease is a rare chronic infectious disease that primarily affects the mucous membranes of the small intestine.
• Infectious enteritis - inflammatory diseases of the small intestine caused by viruses or bacteria.
• Colitis - inflammatory diseases of the mucous membranes of the large intestine.
• Zollinger-Ellison syndrome - a tumor that affects the islet apparatus of the pancreas, actively secreting gastrin - a hormone that causes the stomach to produce an excess amount of hydrochloric acid.
• Diseases characterized by impaired blood circulation: heart failure, portal hypertension (high blood pressure in the portal vein), all kinds of circulatory disorders in the intestines.
• Deficiency of bile salts - an ailment resulting from stagnation of bile in the gallbladder and its ducts.
• The complete absence of alpha-glucosidase, enterokinase, beta-galactosidase and individual pancreatic enzymes.
• From the consequences of prolonged use of anti-inflammatory and antibacterial drugs.

In some cases, the syndrome of impaired intestinal absorption can be provoked by:

• progressive wasting (in patients suffering from bulimia or anorexia);
• anemia (anemia) - a clinical and hematological syndrome characterized by a decrease in the level of hemoglobin and a decrease in the number of red blood cells in the blood;
• hypovitaminosis - an acute deficiency of vitamins in the body;
• increased motor function of the intestine;
• osteoporosis is a clinical condition accompanied by a significant decrease in bone density.

Classification

Depending on the origin, malabsorption syndrome can be:

A special category should include cases of iatrogenic (artificially created by the efforts of surgeons) malabsorption used to treat severe forms of obesity, in the language of physicians called morbid.

There is another type of classification, according to which cases of malabsorption are classified depending on the severity of their clinical course:

• To mild (first degree) include conditions characterized by minor signs of hypovitaminosis, some decrease in performance, general weakness and weight loss, not exceeding ten kilograms.
• To the middle (second) degree include cases in which in the body of a patient who continues to lose weight (body weight loss is more than ten kilograms), the level of sex hormones is significantly reduced, water-electrolyte metabolism is disturbed, anemia and a pronounced deficiency of vitamins and microelements (polyhypovitaminosis) develop.
• To severe (third) degree include conditions accompanied by severe electrolyte and multivitamin deficiency, severe anemia, osteoporosis, convulsions, edema, severe endocrine disorders and significant body weight deficiency. For children with severe malabsorption, there is a significant delay in psychomotor and physical development.

Symptoms

The clinical picture of the malabsorption syndrome is so vivid that an experienced specialist can make a preliminary diagnostic conclusion only on the basis of data obtained during the interview and examination of the patient who first came to the appointment.

The characteristic clinical manifestations of malabsorption are represented by the presence of:

• Diarrhea - frequent (up to fifteen times a day) fetid loose stools that have a mushy (sometimes watery) consistency. The amount of feces in malabsorption is most often increased. If the daily volume of bowel movements fluctuates between 300-2500 g, doctors talk about the presence of polyfecal matter.
• Fat discolored stools - steatorrhea. Having become oily, the feces acquire a clearly visible shiny coating and are poorly washed off the walls of the toilet bowl.
• Severe pain in the abdomen, localized, as a rule, in its upper part and radiating to the lumbar region. Occurring immediately after eating and invariably accompanied by a loud rumbling, they do not go away even after taking antispasmodics and painkillers. In patients with chronic pancreatitis, the pain is girdle, and in patients with low lactase levels, it is cramping.
• Tendencies to a significant (reaching the degree of extreme exhaustion - cachexia) weight loss. Despite a sedentary lifestyle and good nutrition, the patient loses weight without making the slightest effort.
• Constant intense thirst and marked muscle weakness. The culprit of these symptoms is prolonged diarrhea, leading to severe dehydration.
• Significant change in appearance. The patient's skin, becoming dry and dull, is covered with many age spots and polymorphic rashes, acquires a grayish color, and the nail plates become cloudy and become brittle and exfoliating. The patient has active hair loss.
• Increased fatigue. The patient's performance is significantly reduced; during the day he feels constant weakness and drowsiness, and at night he complains of insomnia.
• Iron deficiency anemia is a hematological syndrome characterized by impaired hemoglobin production due to acute iron deficiency and manifested by sideropenia (decreased iron content in blood serum) and anemia.
• Intolerance to milk and products made from it, which occurs even in people who used these products without problems before the onset of the disease. After the development of malabsorption, the use of milk provokes the patient to experience severe cramping pain in the abdomen and increased gas formation.

A separate discussion deserves a symptom of a pronounced deficiency of vitamins and microelements, due to their insufficient intake into the body of a sick person.

In the course of long-term observations of patients suffering from malabsorption syndrome, it was found that:

• Lack of vitamin B, combined with calcium deficiency, provokes increased bone fragility, up to the onset of osteomalacia, a serious condition accompanied by softening and deformation of the bones.
• The lack of vitamins B1 and E is the culprit in the development of all kinds of paresthesias (sensitivity disorders, accompanied by a feeling of crawling "goosebumps", numbness and tingling) and neuropathies (non-inflammatory nerve lesions).
• In patients with hypovitaminosis A, there is a disorder of twilight vision - the so-called "night blindness".
• With vitamin B12 deficiency in patients with short bowel syndrome or Crohn's disease, megaloblastic anemia (colloquially referred to as malignant anemia) occurs - a pathology of hematopoiesis, consisting in a violation of the production of RNA and DNA. This condition is very often accompanied by the development of glossitis - inflammation of the tongue.
• Hypovitaminosis K is manifested by the appearance of subcutaneous hemorrhages and red dots - petechiae - on the surface of the skin.
• The lack of copper and zinc provokes the appearance of a skin rash.
• In patients with impaired electrolyte metabolism, the occurrence of muscle pain and cramps is observed. The combination of hypokalemia (potassium deficiency) and hypocalcemia (calcium deficiency) leads to spasmophilia, a disease accompanied by increased nervous excitability, which is indicated by convulsive twitches of the larynx and extremities. The characteristic signs of this disease are the spasmophilic symptoms of Trousseau and Khvostek.
• In patients suffering from an acute lack of potassium, there is a pronounced symptom of the "muscle roller". The essence of this phenomenon is that after the impact of the neurological hammer on any muscle, a ridge or dimple surrounded by a ridge is formed in this place and for some time (in the most severe patients - up to one minute) remains.
• The most severe cases of electrolyte disturbances and a decrease in the level of protein in the blood are accompanied by the formation of extensive peripheral edema and the occurrence of abdominal dropsy (ascites) - a secondary condition characterized by the accumulation of peritoneal fluid in the abdominal cavity.

In patients suffering from secondary malabsorption, clinical symptoms are also observed, typical of the disease that provoked its development.

Glucose-galactose malabsorption

Glucose-galactose (or monosaccharide) malabsorption (GGM) is a rare genetic disease that can be transmitted exclusively by inheritance and, therefore, is attributed to a special type of pathology we are considering.

The essence of this metabolic disease is the inability of the cellular structures lining the walls of the small intestine to absorb simple carbohydrates: galactose and glucose. The main cause of this pathology is a mutation that occurs in the structure of the gene responsible for the production of a transport protein that moves monosaccharides through the walls of the small intestine.

Monosaccharide malabsorption can be both congenital (manifested from the very first feedings of the baby) and acquired (as a result of various disorders of the digestive organs).

Violating the process of tissue respiration, glucose-galactose malabsorption provokes a delay in the mental and mental development of a newborn child. This is due to a decrease in the level of glucose in the baby's blood, due to the inability of red blood cells to transport oxygen.

A natural consequence of this process is the energy starvation of the cells of the nervous system and the gradual accumulation of galactose metabolites in the child's body (in the cells of his brain, heart muscle, lens, liver, kidneys), which disrupt the functioning of these organs.

The accumulation of galactose metabolites in the liver can lead to the development of cirrhosis. Their high concentration in the tissues of the kidneys and intestines prevents amino acids from entering the bloodstream.

Chronic irritation of the mucous membranes of the small intestine with metabolites of monosaccharides leads to an increase in the level of fluid in it, which significantly complicates the process of absorption of nutrients. This mechanism is the cause of diarrhea, the most characteristic manifestation of glucose-galactose malabsorption.

The clinical symptoms of HGM manifest themselves immediately after the use of any products containing polysaccharides (represented, for example, by dextrin-maltose or starch), monosaccharides (an exception is fructose) or disaccharides (maltose, sucrose and lactose), therefore, a person suffering from this pathology, You will have to permanently eliminate them from your diet.

To date, glucose-galactose malabsorption is considered an incurable disease.

Complications

The main complications of malabsorption syndrome are due to an acute deficiency of nutrients entering the bloodstream.

Thus, malabsorption can lead to the development of:

• Dystrophy.
• Iron deficiency (hypochromic or microcytic) anemia is a syndrome provoked by an acute lack of iron required for the production of hemoglobin. The clinical picture of hypochromic anemia is characterized by the presence of general weakness, drowsiness, fainting, frequent dizziness, a significant decrease in physical endurance and mental performance. The skin of a sick person is distinguished by unnatural pallor. The patient complains of tinnitus, palpitations and shortness of breath that occurs even with minor physical exertion.
• Megaloblastic (B12-folate deficiency) anemia. The cause of this disease is a violation of the synthesis of DNA and RNA, which distorts the normal course of maturation of red blood cells. As a result of these pathologies, an excessive number of megaloblasts, large nucleated cells that are precursors of erythrocytes, appear in the patient's bone marrow. The clinical manifestations of megaloblastic anemia have much in common with the symptoms of iron deficiency anemia. A characteristic reaction of the body to a lack of vitamin B12 is the development of funicular myelosis - a severe lesion of the spinal cord, manifested by the appearance of an unsteady unsteady gait, lethargy of the lower extremities, a feeling of numbness, the development of paresis and, in the most severe cases, paralysis.
• Violations of the reproductive function of the human body (fertility), as a result of which people suffering from malabsorption syndrome cannot produce viable offspring. Men can develop impotence, women have a significant hormonal imbalance, leading to the cessation of menstruation and the inability to conceive, bear and give birth to a child. Many women with malabsorption syndrome are characterized by a complete lack of sexual desire.
• neurovegetative disorders.
• Multiple organ pathologies due to the presence of polyhypovitaminosis and acute deficiency of vital trace elements.

Diagnostics

Leading role in the diagnosis of malabsorption are laboratory studies of feces, blood and urine:

• A complete blood count will indicate the presence of signs of iron deficiency and megaloblastic anemia and hypovitaminosis K, which affects the prolongation of prothrombin time, a laboratory indicator that helps to assess the rate of blood clotting.
• When evaluating the results of a biochemical blood test, the doctor pays attention to the level of albumin, the content of vitamins, calcium and alkaline phosphatase.
• An extended study of fecal masses - a coprogram - will definitely indicate the presence of starch and muscle fibers in them. The lack of certain enzymes can affect the acidity (pH) of feces.
• If a specialist has suspicions that the process of assimilation of fatty acids is disturbed in the patient's body, he may require a test for steatorrhea. Before the collection of feces, the patient undergoes special training, instructing him to consume at least one hundred grams of fat for several days. After collecting daily feces, the laboratory assistant determines how much fat it contains. An indicator not exceeding seven grams is considered normal. If this value is exceeded, there is every reason to assume the presence of malabsorption. Upon receipt of a result exceeding fourteen grams, the gastroenterologist concludes that the pancreas is not functioning properly. Excretion with feces of half (or even more) of the fats that entered the patient's body with food indicates the presence of celiac disease or a severe (third) degree of malabsorption.
• The nature of the violation of absorption in the small intestine is determined using the Schilling test or D-xylose test.
• Sometimes it becomes necessary to perform a bacteriological study of feces.

Instrumental diagnostic procedures in the detection of malabsorption are of an auxiliary nature:

• With the help of a plain radiography of the abdominal cavity, the first manifestations of diseases of the small intestine can be detected. X-ray will indicate the presence of strictures, inter-intestinal anastomoses, horizontal levels of gas or liquid in the blind loops of the small intestine, ulceration of the mucous membranes and intestinal walls.
• Abdominal ultrasound, magnetic resonance and multispiral computed tomography procedures that visualize internal organs help to identify many comorbidities that can provoke malabsorption.
• Endoscopy of the small intestine makes it possible to take tissue samples to perform a series of laboratory tests () and aspirate the contents of the small intestine in order to conduct its bacteriological examination, which can detect the presence of pathogenic microflora and the degree of contamination of the small intestine with all kinds of microorganisms.

Treatment of the syndrome in adults and children

When malabsorption is detected, the patient is prescribed a special diet (the so-called "table number 5"):

• The patient's diet should be frequent (food should be taken every two hours) and fractional.
• The amount of food eaten at a time should not exceed 250 grams.
• To replenish the supply of vitamins, the patient should consume foods containing a large amount of folic acid and vitamins of groups C and B.
• The patient must completely abandon the use of fat, meat and fish of fatty varieties, pastries, mayonnaise, hot sauces and seasonings. It is necessary to remove semi-finished products, canned food, pickles, black coffee, sorrel and spinach from his diet.
• Extremely useful products are: crumbly cereals, lean meats (chicken, veal, rabbit meat), slightly dried wheat bread, sweet berries and fresh fruits, fat-free cottage cheese, fruit and berry jelly and compotes.

Drug therapy is prescribed by a gastroenterologist only after receiving the results of all diagnostic studies. Being engaged in the treatment of malabsorption, the attending specialist will direct all efforts to the treatment of the disease that provoked the occurrence of this pathology.

After assessing the severity of the patient's condition and the severity of clinical symptoms, the doctor may prescribe:

• Parenteral (by injection) administration of trace elements, vitamins, protein and electrolyte mixtures.
• To eliminate dysbacteriosis (a condition characterized by a decrease in the number of beneficial lacto- and bifidobacteria and an increase in the number of pathogenic microorganisms), probiotics are used - preparations prepared from specially dried bacteria. Once in the human intestine, they come to life and, starting to reproduce, gradually restore its normal microflora.
• Antibiotics.
• enzymatic preparations.
• Medicines that help thin and remove bile.
• Painkillers (if you have severe pain).
• Regulators of intestinal motility.
• Immunomodulators.

If there is an underlying disease requiring surgical treatment, the patient is operated on. Most often, surgery is required:

• severe complications of inflammatory intestinal diseases;
• agangliosis (Hirschsprung's disease) - a pathology that occurs as a result of a congenital malformation of the nerve plexuses responsible for the innervation of the large intestine;
• Crohn's disease.

Prevention

Prevention of malabsorption syndrome consists in preventing ailments that can provoke its occurrence. This category includes:

• inflammatory diseases of the intestine, liver, pancreas;
• disorders of the endocrine system;
• diseases of the gastrointestinal tract.

In the presence of congenital pathologies of the enzymatic system, the best prevention of malabsorption is the timely detection of a deficiency of one or another enzyme and its adequate drug correction.

To prevent hypovitaminosis, seasonal use of vitamin and mineral complexes is necessary.

An important preventive value is the proper organization of nutrition, prescribing:

• inadmissibility of overeating;
• taking small portions of food at strictly allotted hours;
• strict restriction of spicy, salty and too fatty foods.

It is possible to significantly reduce the risk of developing malabsorption by abandoning a sedentary lifestyle, making regular physical activity, playing sports, and controlling body weight part of the daily routine.

- a chronic disorder of the processes of digestion, transport and absorption of nutrients in the small intestine. Symptoms of malabsorption include diarrhea, steatorrhea, abdominal pain, hypovitaminosis, weight loss, asthenovegetative syndrome, electrolyte imbalance, anemia. Diagnosis of malabsorption syndrome is based on laboratory (OAC, coprogram, blood biochemistry) and instrumental methods (radiography of the small intestine, MSCT, ultrasound of the abdominal cavity). Treatment is aimed at eliminating the causes of malabsorption, correcting vitamin, microelement, protein and electrolyte deficiencies, and dysbacteriosis.

General information

Malabsorption (impaired absorption in the intestine) is a syndrome characterized by a set of clinical manifestations (diarrhea, steatorrhea, polyhypovitaminosis, weight loss) that develop as a result of a violation of the digestive and transport functions of the small intestine, which in turn leads to pathological changes in metabolism. Congenital malabsorption syndrome is diagnosed in 10% of cases; its manifestations manifest shortly after birth or in the first 10 years of a child's life. The frequency of acquired malabsorption correlates with the prevalence of causally significant diseases (gastrogenic, hepatobiliary, pancreatogenic, enterogenic, etc.).

Malabsorption classification

By origin, there are congenital malabsorption syndrome (in patients suffering from congenital diseases of the enzyme system - Shwachman-Diamond syndrome, cystic fibrosis, Hartnup's disease and other pathologies associated with enzyme deficiency and impaired transport of substances in the cells of the intestinal mucosa) and acquired malabsorption syndrome (as a result of enteritis , Whipple's disease, short bowel syndrome, chronic pancreatitis, cirrhosis of the liver, and other acquired diseases of the gastrointestinal tract).

Symptoms of malabsorption

In patients with malabsorption syndrome, there are changes in the intestines: diarrhea, steatorrhea, bloating and rumbling, sometimes pain in the abdomen. Pain is usually localized in the upper abdomen, may radiate to the lower back or be shingled in nature if chronic pancreatitis occurs. In patients with lactase deficiency, pain of a cramping nature.

With malabsorption, the amount of feces, as a rule, is markedly increased, the feces have a mushy or watery consistency, and are fetid. With cholestasis and malabsorption of fatty acids, the stool acquires a greasy sheen (sometimes blotches of fat) and discolors (steatorrhea). On the part of the nervous system, asthenovegetative syndrome manifests itself - weakness, fatigue, apathy. This is due to a violation of water-electrolyte homeostasis and a lack of substances necessary for the nervous system.

Pathological changes in the skin: dryness, age spots, dermatitis, eczema, hair loss, brittleness and clouding of nails, ecchymosis - are associated with a lack of vitamins and trace elements. For the same reasons, glossitis (inflammation of the tongue) is often noted. Vitamin K deficiency is manifested by the formation of petechiae (red dots on the skin) and subcutaneous hemorrhages.

In severe violations of electrolyte metabolism and low protein content in the blood, patients have pronounced peripheral edema, ascites (accumulation of fluid in the abdominal cavity). All patients suffering from malabsorption syndrome are prone to progressive weight loss. Deficiency of vitamins E and B1 leads to severe disorders of the nervous system - paresthesia, various kinds of neuropathy. Hypovitaminosis A leads to "night blindness" (twilight vision disorder). A consequence of vitamin B12 deficiency is megaloblastic anemia (often develops in people suffering from Crohn's disease and short bowel syndrome).

Violation of electrolyte metabolism is manifested by convulsions and muscle pain (calcium deficiency in combination with vitamin D deficiency leads to osteoporosis), with hypocalcemia, combined with hypomagnesemia, patients have positive symptoms of Khvostek and Trousseau, hypokalemia is characterized by the “Muscular roller” symptom, which indicates a neuromuscular disorder. - muscle conduction. With a deficiency of zinc and copper, a rash occurs on the skin. With secondary malabsorption syndrome, patients also have symptoms characteristic of the disease that caused its development.

Complications of malabsorption

The main complications of malabsorption syndrome are associated with a lack of nutrients entering the blood: anemia (iron deficiency and vitamin-dependent megaloblastic), fertility disorders, neurovegetative disorders, dystrophy, multiple organ pathologies associated with polyhypovitaminosis and microelement deficiency.

Diagnosis of malabsorption

With malabsorption syndrome, the main signs are detected by laboratory testing of blood, feces, urine. In the general blood test, there may be signs of anemia (iron deficiency and B12 deficiency), vitamin K deficiency affects prothrombin time (lengthening occurs). In a biochemical analysis, the level of albumin in the blood, calcium and alkaline phosphatase are noted. A study of the amount of vitamins is being carried out.

A study of feces shows an increase in its daily volume (with fasting - a decrease). The coprogram detects the presence of muscle fibers and starch in the feces. With some enzyme deficiencies, fecal pH may change. If fatty acid malabsorption is suspected, a test for steatorrhea is performed.

Before starting to collect feces for the study, it is necessary that the patient consumes about 100 grams of fat per day for several days. Then the daily feces are collected and the amount of fat in it is determined. Normally, it should not be more than 7 grams. If the fat content in the feces exceeds this value, malabsorption may be suspected. With more than 14 grams of fat, functional disorders in the pancreas are likely. In the case of severe malabsorption and celiac disease, half or more of the fats received from food are excreted in the feces.

Functional tests to detect absorption disorders in the small intestine - D-xylose test and Schilling test (B12 absorption assessment). As an additional diagnostic measure, bacteriological examination of feces is carried out. An x-ray examination can reveal signs of a disease of the small intestine: blind loops of the small intestine, horizontal levels of liquid or gas can form in some loops, interintestinal anastomoses, diverticula, strictures, and ulcerations are visible.

During abdominal ultrasound, MSCT and magnetic resonance imaging, the abdominal organs are visualized and their pathologies are diagnosed, which may be the root cause of the developed malabsorption syndrome. Endoscopy of the small intestine reveals Whipple's disease, amyloidosis and lymphangiectasia of the intestine, allows you to take material for histological examination, aspirate the contents of the intestine for bacteriological examination (for excessive contamination of the small intestine with microorganisms and the presence of pathological flora).

As additional diagnostic measures, the state of external secretion of the pancreas is assessed (secretin-cerulein, bentriamine, LUND and PABA tests, determination of the level of immunoreactive trypsin); identify the syndrome of excessive bacterial growth (respiratory hydrogen and carbon dioxide tests); diagnosing lactase deficiency (lactose test).

Malabsorption treatment

In the treatment of malabsorption syndrome, the primary task is to treat the disease that caused the development of this condition.

Depending on the severity and severity of clinical symptoms, the gastroenterologist prescribes a special diet for the patient, vitamins and microelements, electrolyte and protein mixtures are administered parenterally. Dysbacteriosis is corrected with the help of pro- and eubiotics, rehydration is carried out (recovery of fluid lost by the body). If the underlying disease requires surgical intervention, then patients undergo surgical treatment for the underlying pathology. Surgery is often prescribed for patients suffering from Crohn's disease, intestinal lymphangiectasia, Hirschsprung's disease, and severe complications of inflammatory bowel disease.

Prevention of malabsorption

Preventive measures against the development of malabsorption syndrome should be primarily aimed at preventing diseases that contribute to its occurrence - disorders of the digestive tract, inflammation of the intestines, pancreas, liver, endocrine disorders. In case of congenital defects of the enzymatic system, preventive measures will be the timely detection of one or another enzyme deficiency and its drug correction.

Prognosis for malabsorption

Sometimes in mild cases, malabsorption syndrome is corrected with diet. In other cases, the prognosis for this disease directly depends on the course of the underlying pathology, the severity of absorption disorders and the insufficiency of the intake of substances into the blood.

If the main factor that caused the occurrence of this syndrome is eliminated, correction of the consequences of prolonged dystrophy may take a long time. The progression of malabsorption threatens the development of terminal conditions and can lead to death.

Malabsorption is a chronic pathological process associated with a disorder in the digestive process (meaning the breakdown of complex, polymeric molecules of proteins, starch and fats into monomers - amino acids, glucose, glycerol and fatty acids), transportation and absorption of already split substances. Manifestations of this process, of course, will be one way or another associated with a lack of nutrients in the human body. Violation of protein, fat and carbohydrate metabolism, severe beriberi and anemia - all this will lead to the development of dyspeptic and asthenovegetative syndrome, hair loss, memory impairment, visual impairment and many other disorders that occur with metabolic dysfunction. To diagnose this process, both general clinical and special instrumental studies are used, the main purpose of which is to exclude the possibility of the presence of any organic pathology (oncological neoplasm, helminthiasis, or any other pathological process, to a certain extent associated with this kind of symptoms). ). Accordingly, the treatment of the disease in question should be aimed both at eliminating the causes that caused malabsorption, and at eliminating all the consequences of this condition.

Another definition of malabsorption syndrome is as follows: malabsorption is a pathological condition that leads to a violation of the intake of one or more groups of nutrients into the human body, the cause of which is a violation of their insufficiency of absorption in the small intestine. According to most experts, it is this definition that is more true, as it clearly shows the causal relationship between the etiological factor and the manifestations of the disease.

Classification of malabsorption syndrome

Depending on the origin of this disease, it is customary to distinguish:

1. The primary form - in this case, the disease develops due to a congenital lack of enzymes that break down polymers or dimers (substances consisting of two molecules). Examples of such conditions are congenital fructose intolerance, glucose-galactose intolerance, malabsorption of many amino acids (otherwise referred to as Hartnup's disease), problems with the absorption of vitamin B12 or folic acid;
2. The secondary form is caused by the presence of any organic pathology of the gastrointestinal tract or other organs functionally related to the digestive system. Most often, malabsorption syndrome is combined with pathologies such as pancreatitis, cholecystitis, hepatitis, stomach ulcers, colitis, gastritis, enteritis, celiac disease, various pathologies of the thyroid gland and the central nervous system. In the vast majority of cases, one has to deal with precisely such forms of the disease, for the simple reason that they are much more common;
3. Very rarely, but there are cases when malabsorption is due to dysbacteriosis or an increased evacuation function of the intestine, also refusing to eat, or simply a violation of the meal schedule.

In addition, clinicians - gastroenterologists proposed another classification of this disease, which provides for a more practical approach and links the degree of development of the pathological process and the general condition of the patient:

• 1 degree implies a weight loss of not more than ten kilograms, severe weakness, apathy, decreased performance and minor manifestations of hypovitaminosis;
• Grade 2 - weight loss of more than ten kilograms, pronounced signs of polyhypovitaminosis, pathological changes in water and electrolyte homeostasis, a decrease in hemoglobin levels, a violation of the synthesis of certain hormones;
• Grade 3 - significant deficiency of body weight, vitamin deficiency, severe multivitamin and electrolyte disorders, osteoporosis, severe anemia, swelling of the legs and abdomen (oncotic, associated with low protein content in the body, convulsions, severe endocrine disorders).

It should be noted that it is in accordance with this classification that the patient is treated, since in this case the severity of the patient's health condition is considered, and not biochemical and pathophysiological mechanisms.

What are the manifestations of malabsorption syndrome in dynamics?

The very first symptom that manifests itself in violation of the absorption of some nutrients is dyspeptic disorders. That is, there is a pronounced flatulence, a violation of the stool occurs (as a rule, it is characterized by severe diarrhea, in which a large amount of liquid consistency with an unpleasant odor is released, as laboratory assistants indicate - with a whitish tinge). This phenomenon is called steatorrhea - that is, there is a violation of the absorption of fats, which are brought out almost unchanged. In addition, the patient will periodically experience vomiting and even bouts of vomiting, which will not bring any relief - this is quite understandable, since the violation of the enzymatic processing of food will in no way change from the fact that undigested food residues are removed. Another characteristic symptom is abdominal pain. Its features will be in a sluggish nature (that is, the pain is not paroxysmal, dagger-like, but mild, lasting for a long period of time), in terms of localization - mainly in the upper abdomen (in the projection of the small intestine), irradiation is possible in the back and in the area of ​​\u200b\u200bthe heart (it happens quite rarely).

The second symptom, which is very characteristic of malabsorption, is a pronounced asthenovegetative syndrome. It consists in increased fatigue, drowsiness, apathy, lack of appetite, distracted attention. It occurs due to a violation of the intake of vitamins necessary for the adequate functioning of the nervous system.

In the event that the lack of intake of vitamins E and B1 into the human body is significantly pronounced, then this will lead to more serious consequences - neuropathies (that is, a violation of peripheral sensitivity is implied when a person is unable to distinguish cold from hot with his fingertips, for example). Hypovitaminosis A causes "night blindness" (impaired twilight vision). Due to the lack of vitamin B12, severe megaloblastic anemia occurs (it is this pathology that often occurs in people suffering from Crohn's disease and short bowel syndrome).

Problems with the exchange of electrolytes (meaning a violation of the content of potassium, calcium, magnesium, sodium and chlorine ions) leads to more unfavorable changes. Insufficiency of calcium ions leads to cramps and muscle pain (in the event that there is still not enough vitamin D3, then, among other things, osteoporosis will occur). With calcium deficiency, combined with hypomagnesemia, patients experience positive symptoms of Khvostek and Trousseau, hypokalemia is accompanied by a symptom of "Muscle Roll" (it consists in a violation of the patency of the neuromuscular impulse). In the event that there is a deficiency of zinc and copper in the body, a characteristic exanthema (rash) will occur.

A change in the structure of the skin will also be characteristic - hair loss will begin, severe dryness of the skin, age spots, dermatitis and other rashes will appear. Violations of the absorption of vitamin K will be manifested by pronounced petechiae on the skin, and glossitis (inflammation of the tongue) will also be characteristic.

In the later stages of malabsorption, insufficient protein content in the human body will already appear. Due to the reduced oncotic pressure, which is maintained by albumins, the blood plasma exits the vessels into the interstitium (surrounding tissues) - thus, pronounced edema of the feet and legs occurs, in case of an increase in symptoms, ascites occurs (accumulation of fluid in the abdominal cavity).
It is important to understand that all the above symptoms are characteristic of both primary and secondary malabsorption, however, if the absorption of a substance is caused by any organic pathology (that is, secondary malabsorption occurs), then to all The above symptoms are also accompanied by manifestations of primary pathology.

Malabsorption in pediatric practice

This issue is very relevant, since the vast majority of primary (congenital, genetically determined) forms of malabsorption syndrome manifest themselves precisely in the neonatal period. It should be noted that in children this symptomatology is quite pronounced, however, even despite this, the diagnosis of the pathology in question in this case is very difficult, due to the impossibility of collecting complaints and anamnesis. The first sign that will make you think is a violation of the digestive process, manifested by constant bloating, impaired stool and severe anxiety. However, in order to confirm this diagnosis, it is necessary to conduct a thorough differential diagnosis for the simple reason that many pathologies have similar symptoms, which are much more threatening to the health and life of the newborn.

Be that as it may, parents should remember that if such symptoms appear, professional medical care will be required in any case.

Diagnostic algorithm for malabsorption syndrome

For the diagnosis of maabsorption syndrome, first of all, general clinical studies are carried out. They include the following analyses:

1. Complete blood count - a characteristic change will be anemia and a decrease in the number of red blood cells, their shape may change (megaloblastic anemia);
2. Biochemical blood test (decrease in protein concentration due to a violation of its absorption in the intestine, severe violations of the electrolyte complex);
3. Study of feces. For the diagnosis of the pathology under consideration, this study is very important, since it allows you to determine exactly which component of the food is not absorbed. In the results of the coprocytogram, the presence of a large amount of muscle fibers and starch will be noted. With enzymopathies, the pH of feces can change. In the same case, if the color of the feces becomes white, then it is necessary to conduct an additional study to determine steatorrhea - a violation of the absorption of fats. Preparation for this study involves eating about 100 grams of fat per day for two to three days. After that, the collection of daily feces is carried out, followed by the determination of the amount of fat in it. The normal value does not exceed 7 grams (per 100 grams of undigested food residue). In the event that the value of this indicator is more than 7, but less than 14 g, there is every reason to suspect the presence of malabsorption. In the event that the amount of fat exceeds 14 grams, then in this case, most likely, there will be any violations of the pancreas. Another feature - with celiac disease, more than half of the fats that are in the gastrointestinal tract are excreted with feces.

Adjusting for the need for differential diagnosis, it would be worthwhile to perform an ultrasound examination of the abdominal organs and a plain radiograph, since it is these studies that will help to establish the primary cause of malabsorption in the intestine (in the case of secondary malabsorption syndrome, which occurs much more often).

Treatment

It is carried out only under the supervision of a gastroenterologist. The most important thing in this case is to follow a diet with the exception of those food components that the body is not able to absorb. It will be very important to prescribe special dietary mixtures, with the content of minerals, vitamins and other nutrients that a person lacks, necessary to normalize metabolism. The intestinal microflora is corrected by taking probiotics, the restoration of water and electrolyte metabolism is shown. In the event that there is any primary pathology, it is treated, in most cases, surgically.

Malabsorption refers to the inability of the body to absorb essential nutrients from the digestive tract. The list of causes, symptoms, complications of this syndrome is simply overwhelming. Due to the huge number of etiological factors (about 200), the treatment of malabsorption syndrome is based on determining the exact cause of this condition.

What is malabsorption?

Malabsorption refers to any condition in which one or more essential nutrients (nutrients) are not over-digested or not absorbed properly in the intestine. This syndrome can be congenital or acquired, and absorption disorders concern both fats, proteins and carbohydrates, as well as electrolytes, vitamins and minerals.

An example of congenital malabsorption is glucose-galactose intolerance, an extremely rare disease caused by a genetic abnormality on chromosome 22. Only a few hundred people have been found to have the disease worldwide. Acquired malabsorption may be due to any disease (eg, diabetes, chronic pancreatitis, cystic fibrosis, atrophic gastritis), certain surgery (eg, resection of the intestine or stomach), medication (eg, laxatives).

Malabsorption syndrome can affect both children and adults. Nevertheless, this condition poses a great danger to the growing body of the child, which needs all the nutrients for proper development. The lack of these substances, observed in malabsorption, can lead to a delay in growth and maturation.

Disease classification

There are several classifications of malabsorption syndrome. On the one hand, there are three main categories:

• selective malabsorption. In this form, the absorption of only one substance is impaired (for example, lactose intolerance).
• Partial malabsorption. The absorption of a group of substances is impaired (for example, abetalipoproteinemia is a hereditary disease in which the absorption of fats, cholesterol and fat-soluble vitamins is impaired).
• total malabsorption. The absorption of all nutrients is impaired.

Another classification is based on the type of nutrients whose absorption is impaired.

Impaired absorption of carbohydrates

Diagram of carbohydrate absorption in the intestine

Carbohydrates under the action of various enzymes in the intestine (amylase, lactase, sucrase-isomaltase) break down to glucose, galactose and fructose, which are absorbed into enterocytes and enter the bloodstream from them. Violations of this process can be congenital (cystic fibrosis and Shwachman-Diamond syndrome, which can cause amylase deficiency; lactase deficiency; sucrase-isomaltase deficiency) or acquired - lactase deficiency due to viral enteritis or celiac disease.

Absorption problems proteins

Diagram of protein absorption in the intestine

Proteins are broken down in the gastrointestinal tract by the action of enzymes (pepsin, trypsin, enterokinase, proteases and peptidases) to peptides and amino acids, which are absorbed by the cells of the intestinal mucosa. Congenital disorders of protein digestion include diseases such as cystic fibrosis, Schwachman-Diamond syndrome, and enterokinase deficiency. Acquired protein absorption disorders are not specific (that is, they also disrupt the absorption of carbohydrates and fats), developing in diseases that damage the intestinal mucosa - viral enteritis, celiac disease, enteropathy with an allergy to cow's milk protein.

Poor digestibility fat

Diagram of fat absorption in the intestine

Lipase, colipase and bile acids are involved in the absorption of fats in the intestine. Violations of these processes can be congenital (with cystic fibrosis and Shwachman-Diamond syndrome, causing a lack of lipase and colipase; primary malabsorption of bile acids, which leads to a decrease in their concentration) or acquired - secondary to diseases of the liver and biliary tract or to chronic pancreatitis. It is also clear that any disease that leads to damage to the intestinal mucosa can cause problems with the absorption of fats.

Forms of primary disorders of nutrient absorption - table

Causes

Most nutrients, including proteins, fats, and carbohydrates, are absorbed in the small intestine. For their proper absorption, a complete set of appropriate enzymes, a healthy state of the intestinal mucosa is required. With any violation of these factors, malabsorption syndrome can develop. There are about 200 possible causes of nutrient absorption disorders, which can be divided into four groups.

1. Damage to the mucosa of the gastrointestinal tract:

   celiac disease - develops as a result of an allergy to gluten, leads to atrophy of the intestinal mucosa;

   intolerance to cow's milk protein, soy, fructose;

   infectious diseases (giardiasis, helminthic invasions, intestinal tuberculosis);

   immunodeficiency, including enteropathy in HIV.

2. Disorders within the intestinal lumen:

   diseases of the pancreas (cystic fibrosis, chronic pancreatitis, pancreatic cancer);

   violations of the secretion of bile acids;

   taking medications.

3. Structural changes in the intestine:

   surgical interventions (resection of the stomach or intestines);

   • diverticula and strictures;

     Crohn's disease;

     amyloidosis;

     radiation enteritis.

4. Disorders that do not affect the intestines:

   thyroid diseases (hypothyroidism and thyrotoxicosis);

   Addison's disease;

   diabetes;

   diseases of the parathyroid glands;

   malignant neoplasms;

   collagenoses;

   cardiovascular diseases.

Symptoms of pathology

The clinical picture of malabsorption syndrome depending on the substance, the absorption of which in the intestine is impaired

Some symptoms of malabsorption are caused by the passage of unabsorbed nutrients through the digestive tract, others are caused by a deficiency of these nutrients in the body. Common manifestations of malabsorption are:

• diarrhea;
• changes in stool consistency and odor;
• flatulence;
• discomfort or pain in the abdomen;
• fatigue;
• weight loss;
• nausea and vomiting;
• increased susceptibility to infectious diseases.

Signs indicating a nutrient deficiency - table

Diagnostics

If a person suffers from persistent diarrhea, nutritional deficiencies, and gradual weight loss despite eating well, a doctor may suspect a malabsorption syndrome. Various examination methods are used to confirm the diagnosis.

In combination with a medical examination, various laboratory tests can be used to establish an accurate diagnosis:

• Complete blood count - to detect anemia.
• Determination of the level of vitamin B12, iron, electrolytes (potassium, magnesium, calcium, sodium) in the blood.
• Clotting tests - to detect possible vitamin K deficiency.
• Blood chemistry.
• Determination of the secretory function of the pancreas.
• Coprogram (fecal analysis) - in order to detect unabsorbed substances in the stool.
• Carbohydrate and lactose absorption tests.
• Detection of autoantibodies in celiac disease.

To determine the cause of the malabsorption syndrome, as well as in the framework of the differential diagnosis of the disease (for example, from maldigestia - a systemic digestive disorder), the following instrumental methods are sometimes used:

• radiopaque examination of the intestine;
• ultrasound examination of the abdominal organs;
• endoscopic examinations of the esophagus, stomach, duodenum and colon;
• computed or magnetic resonance imaging of the abdominal organs;
• biopsy of the intestinal mucosa.

Based on the results of diagnostic measures, not only the presence of the disease is established, but also the degree of its severity.

The severity of malabsorption syndrome - table

Treatment

The choice of treatment method depends on the disease that caused the development of malabsorption syndrome. Significant relief of symptoms can be achieved with non-drug treatments, including lifestyle changes, probiotics, and vitamins.

Nutrition and non-drug therapy

Although there are about 200 possible causes of malabsorption, the treatment of which can vary greatly, a few basic principles can be applied to almost any form of this problem:

• It is necessary to follow the recommendations given by the doctor, take the drugs prescribed by him.
• It is necessary to avoid eating foods that are difficult to digest in the intestines and worsen the clinical picture.
• You need to plan your diet, taking into account the main cause of malabsorption. For example, a common culprit for this syndrome is lactose or gluten intolerance.
• It is important to drink plenty of water to help flush out toxins from the body.
• You need to find out which foods are better absorbed in combination with others.
• It is important to replace lost nutrients with alternative foods.

Patients with malabsorption syndrome are usually recommended a diet high in protein and reduced in fat (especially if fat absorption is impaired). Sometimes special mixtures for enteral nutrition are used, which have a balanced composition of fats, proteins and carbohydrates. If self-feeding is not possible, such mixtures can be introduced into the stomach through a special probe. In severe cases, parenteral nutrition can be used, which consists of administering nutrients intravenously. However, this method has many disadvantages and complications.

In children with malabsorption syndrome, it is important to determine its exact cause, after which a nutrition plan for the baby is developed taking into account it. It may include specialized infant formulas for infants that do not contain those substances whose absorption is impaired. An example is the Nutrilon Malabsorption formula, which is formulated in such a way that it greatly facilitates the absorption of nutrients.

However, it should be noted that in any case of malabsorption syndrome in a child, a doctor should be consulted on the issue of his nutrition.

Diet for celiac disease in adults and children - video

Medical therapy

Depending on the cause and symptoms of malabsorption syndrome, your doctor may prescribe the following medications:

• Vitamins (cyanocobalamin, nicotinamide, folic acid) - are prescribed for their deficiency.
• Minerals - preparations of iron (Sufer, Ferrumlek), calcium (Calcium D3 Nycomed), potassium (Kalipos), magnesium (magnesium sulfate).
• Antibacterial drugs (Amoxicillin, Tetracycline, Ceftriaxone, Rifaximin) - are used for the infectious origin of malabsorption syndrome. The choice of a specific antibiotic is made only by a doctor, based on the exact cause of the disease.
• Hormonal drugs (Prednisolone) - are prescribed for inflammatory diseases (Crohn's disease), celiac disease and Whipple's disease.
• Antisecretory (Sandostatin) and antidiarrheal (Loperamide) drugs - reduce secretion in the intestine and reduce its motility.
• Pancreatic enzymes (Creon, Pangrol) - are prescribed for insufficient secretion of its own enzymes by the pancreas.
• Antacids (omeprazole, pantoprazole, famotidine) are prescribed to reduce the risk of stomach and duodenal ulcers.
• Probiotics (Linex, Enterogermina) - improve intestinal microflora and nutrient absorption.

It is important to know that folk remedies (decoctions and infusions of herbs, vegetable and fruit juices) cannot replace medicines, they only have a general strengthening effect. However, self-medication can have a detrimental effect on the patient's condition, therefore, in any case, consultation with a specialist is necessary.

Medications in the photo

Surgery

Some patients in whom comorbidities are connected to the malabsorption syndrome may be treated with surgical operations:

• In Crohn's and Hirschsprung's diseases, ulcerative colitis, the affected area of ​​the large intestine is removed.
• In cholelithiasis, the gallbladder and stones from the biliary tract are removed.
• In severe liver diseases, liver transplantation is possible.

Possible complications and prognosis of recovery

With prolonged malabsorption of nutrients, the following may develop:

• slow growth in childhood;
• infertility;
• anemia;
• rickets, osteomalacia or osteoporosis;
• the formation of stones in the gallbladder and kidneys.

The prognosis for recovery from malabsorption syndrome depends on what cause it is caused by. For example, with viral enteritis, after its elimination, the intestinal mucosa is quickly restored. Other causes of malabsorption syndrome can be systemic and progressive, reducing the life expectancy of patients.

Malabsorption syndrome is a rather serious condition that can not only significantly worsen the quality of a person’s life, but also carry a quite tangible danger to his life. However, early detection and rational treatment significantly improve the patient's well-being and facilitate the course of the disease.