Malabsorption - causes, first signs, symptoms and treatment of malabsorption syndrome. Symptoms of malabsorption syndrome in children, hidden threat, treatment and prevention of pathology

Malabsorption syndrome in a child signals obvious disorders in the body that should be eliminated as soon as possible. In the article you will learn how to recognize this pathology in time, what caused it and how to overcome it.

What is this syndrome and what happens in the body

Malabsorption or SMA is a disease of the gastrointestinal tract, characterized by the inability of the intestine to absorb the necessary substances. Malabsorption is not an independent disease and acts as a complex of symptoms in the development of most diseases of the gastrointestinal tract.

The syndrome occurs against the background of the inability of the intestine to digest food and extract useful substances (). Malabsorption and maldigestion are inseparable and develop in the child's body in parallel.

Depending on the type of malabsorption, the child's body is deprived of useful trace elements, a significant amount of vitamins, minerals. The organs of the gastrointestinal tract lose the ability to break down and absorb useful substances, due to enzyme dysfunction. The child loses strength, the body is exhausted, there are problems with the work of other organs.

Features of the condition in young children

Malabsorption syndrome in young children can lead to serious disorders of physical and mental development.

At this age, special attention is paid to the correction of the nutritional status of the patient, that is, to. Due to the loss of trace elements, vitamins and minerals, the child may develop deficiency syndromes (loss of amino acids, protein, electrolytes).

Especially dangerous syndrome for infants, because with ineffective treatment, it threatens with exhaustion of the body and, in severe cases, death.

Classification of violations

There are two types of SMA:

Causes

The causes of intestinal malabsorption are as follows:

Symptoms of malabsorption are pronounced and very noticeable. During the first examination, a preliminary diagnosis can be made based solely on these claims.

Specific Symptoms

1. Diarrhea. Frequent urination to the toilet is typical (up to 15 times a day).
2. Change in color and structure of fecal matter.
3. (cramping, spasmodic).
4. Bloating, flatulence.
5. Round belly.
6. Rapid weight loss.
7. Decreased appetite.
8. Vomiting reflex.
9. Nausea.
10. Arbitrary / involuntary release of gas formations.
11. Intolerance to dairy products (with galactose malabsorption).

Non-specific

1. Pallor. Read about the causes of marbled skin in a baby.
2. Slow down or stop physical development.
3. Constant feeling of tiredness.
4. General weakness.
5. Brittle nails, hair loss.
6. Drowsiness.
7. Visual impairment.
8. Skin disorders (dry skin, dermatitis).

Table of symptoms of digestibility disorders:

Differential diagnosis and analyzes

First of all, you need to contact a pediatrician and a gastroenterologist, who will subsequently prescribe all the necessary tests and examinations. Depending on the results obtained, an accurate diagnosis will be established and treatment options will be proposed.

If maldigestion is suspected, examinations are carried out:

Medical treatment is also necessary. To improve the functioning of the pancreas, Creon, Pantsitrat, Mezim forte are indicated for use. Lactobacterin helps to restore the intestinal microflora. In the 2nd and 3rd stages, antibiotics such as Tetracycline or Amoxicillin may be prescribed.

Children, to restore the level of iron in the blood, are prescribed folic acid. For pain relief, the doctor may prescribe antispasmodics: No-shpa, Drotaverine.

If serious diseases such as Crohn's disease, intestinal lymphangiectasia, and others have become the cause of malabsorption, a surgical option is possible.

Special diet with mixtures

Malabsorption syndrome in young children can be eliminated with formula milk, which is an alternative to mother's milk.

Features of mixtures:

• the introduction of biologically active compounds;
• saturation with microelements, vitamins for the development of the brain, vision and nervous system;
• easy digestibility by the intestines;
• fast absorption.

Babies can be attributed to mixtures such as Peptamen, Nutrien Elemental, Nutrilon. Read more about how to choose a quality formula for newborns is described in.

Prohibited Products

In case of intolerance to sucrose - stop the use of sugar, potatoes, confectionery. With the inability to absorb lactose, the amount of mother's milk and milk of animal origin is reduced or excluded.

With celiac disease (see more details), it is forbidden to eat millet, barley, legumes (beans, peas), bakery products. Glucose-galactose malabsorption excludes products containing sucrose, starch, maltose from the diet.

Consequences and complications

It should be noted that among the diseases associated with the work of the gastrointestinal tract, SMA occupies a special place. It differs from other syndromes in the prevalence and severity of the course. For children, SMA is really dangerous if you do not see a doctor in time.. Parents should pay more attention to the nutrition of children, to complaints and obvious symptoms. Timely treatment can eliminate the problem in the shortest possible time.

Malabsorption syndrome can provoke the development of iron deficiency anemia, hypovitaminosis, anorexia, mental disorders, slowing down of physical and mental development. With untimely treatment, the syndrome of glucose-galactose malabsorption can develop a child and loss of vision.

Failure to follow the doctor's instructions and diet can cause complete exhaustion of the body and even death.

1. Feeling the deterioration of health and dysfunction of the digestive system, do not postpone going to the doctor.
2. In the presence of chronic diseases, annually undergo honey. survey.
3. Power control:

• Eat healthy and healthy food;
• A minimum of fried, salty and spicy;
• Fractional meals (6 times a day);

1. Take vitamin and mineral complexes.

Conclusion

Intestinal malabsorption is a syndrome that should never be ignored, especially when it comes to your child's health. We hope that this article was useful and you found answers to all your questions. Take care of the kids and don't get sick!

Malabsorption syndrome in children, or malabsorption syndrome, is a complex of clinical symptoms that develop due to a disorder in the digestive and transport capacity of the small intestine, and this leads to a deterioration in metabolism. Malabsorption syndrome is manifested by diarrhea, steatorrhea, multivitamin deficiency, weight loss.

Causes of malabsorption

Malabsorption can be caused by more than 70 diseases of the digestive system, including megaloblastic anemia, vitamin D-resistant rickets, pathologies associated with impaired amino acid metabolism, etc., but in medicine the term "malabsorption" is used only for those diseases that are accompanied by deficiency nutrition and enteral syndrome.

Depending on the severity of the disorder, malabsorption is divided into:

• 1 degree. A person's weight decreases by less than 10 kg, there are signs of asthenovegetative syndrome and multivitamin deficiency (weakness, apathy, fatigue);
• 2 degree. Body weight decreases by more than 10 kg, multivitamin deficiency is pronounced, electrolyte deficiency, anemia, decreased functions of the gonads are diagnosed;
• 3 degree. A body weight deficiency develops, patients suffer from a lack of many vitamins and a deficiency of electrolytes, convulsions may occur, anemia, osteoporosis, edema, and endocrine disorders develop against the background of a lack of nutrients.

Malabsorption syndrome can be caused by congenital disorders or develop against the background of acquired diseases.

Congenital malabsorption is the cause of 10% of cases of the disorder. It is formed against the background of celiac disease, cystic fibrosis, Shwachman-Diamond syndrome, lactase deficiency, sucrose or isomaltose, disaccharide deficiency, Hartnup's disease, cystinuria.

Acquired malabsorption can develop after the child has had enteritis, and also if he suffers from intestinal lymphangiectasia, tropical sprue, short bowel syndrome, oncology of the small intestine, chronic pancreatitis, cirrhosis. The syndrome is associated in 3% of patients with intolerance to cow's milk protein, which can develop at any age.

Symptoms

The clinical picture includes non-specific and specific symptoms. Nonspecific signs include manifestations that occur with many pathologies of the gastrointestinal tract, and on their basis it is impossible to establish a correct diagnosis. These symptoms include:

• weakness, fatigue, apathy;
• weight loss with normal nutrition (this symptom is more pronounced in children with celiac disease and Whipple's disease);
• bloating, cramping or girdle pain in its upper part, rumbling, intestinal motility is noticeable to the eye;
• flatulence (the release of digestive gases) occurs when there is an excessive amount of bacteria in the small intestine;
• diarrhea;
• steatorrhea (fatty feces), the volume of stools is increased, they are mushy or watery, fetid, acholic (if too little bile acids enter the intestines).
• dry skin, brittle hair and nails, dermatitis, glossitis, ecchymosis.

Specific signs of pathology, that is, those that indicate malabsorption syndrome, are as follows:

• peripheral edema. This symptom develops as a result of hypoproteinemia. The feet and legs usually swell. If the syndrome is severe, then ascites is formed, which is associated with impaired protein absorption, loss of endogenous protein and hypoalbuminemia;
• changes caused by multivitamin deficiency. A sign of hypovitaminosis is a change in the skin, mucous membrane and tongue. In people with a lack of vitamins, the skin is dry and flaky, cheilitis, glossitis, stomatitis develops, age spots appear on the body or face, the nail plates change color and exfoliate. Depending on which elements cannot be absorbed in the small intestine, corresponding disorders appear. With a lack of vitamin K, the gums begin to bleed, petechial or subcutaneous bruising occurs. "Night blindness" appears with a lack of vitamin A. If there is a deficiency of vitamin D, then patients have bone pain. The lack of a sufficient amount of vitamin B 12 leads to the development of megaloblastic anemia, and the lack of vitamins B 1 and E causes paresthesia and neuropathy;
• deviation from the norm of mineral balance. The mineral composition of the blood is disturbed in all people with malabsorption syndrome. Lack of potassium leads to convulsions, myalgia, paresthesia, bone pain. Deficiency of potassium and magnesium contributes to the increased excitability of the nervous system and the positive symptoms of Chvostek and Trousseau. In severe cases, with a small amount of calcium and vitamin D in the blood, osteoparosis of the tubular bones, pelvis and spine occurs. In patients with impaired absorption of zinc, iron and copper, a rash on the skin is visible, iron deficiency anemia, hyperthermia are detected;
• disruption of the endocrine system. In severe and prolonged course of the disorder, signs of polyglandular insufficiency appear. The gonads cease to function normally (libido and potency decrease, menstruation is disturbed or it disappears altogether). Calcium malabsorption leads to hyperparathyroidism.

In patients with malabsorption syndrome, of course, there are also signs of the underlying disease, which provoked a disorder of the absorption function.

Children are most often diagnosed with:

• glucose-galactose malabsorption;
• gluten intolerance;
• malabsorption of fats, carbohydrates or proteins;
• monosaccharide deficiency;
• lactose deficiency;
• malabsorption of minerals.

If fats enter the large intestine, they also capture fat-soluble vitamins, which leads to their deficiency. Due to the development of pathogenic microflora, the absorption of bile salts is limited, and these acids irritate the large intestine, which leads to diarrhea.

If carbohydrates are poorly absorbed, then the microflora in the large intestine quickly develops, which breaks down incoming carbohydrates into simpler compounds, including fatty acids, carbon dioxide and methane, and this provokes diarrhea and increased gas formation. If there is a lack of proteins, then this leads to a lack of amino acids.

Diagnostics

Malabsorption syndrome may be suspected in patients with frequent diarrhea, weight loss, and anemia. When collecting an anamnesis, it is necessary to clarify when the first symptoms occurred. Congenital intestinal lymphangiectasia most often manifests itself at the age of eleven, celiac disease makes itself felt when the child is 9 months -1.5 years old.

Short bowel syndrome (SBS), against which malabsorption develops, occurs immediately after surgery on the abdominal cavity. The doctor must establish the sequence of symptoms. This is important because in Whipple's disease, signs of joint damage first appear, with lymphangiectasia, pronounced, symmetrical edema and diarrhea initially occur.

To establish the presence of malabsorption syndrome allow laboratory methods. The patient must take blood, urine, feces for analysis. A clinical blood test for malabsorption reveals anemia, which means that folic acid and iron are poorly absorbed.

If inflammatory and destructive processes also occur in the ileum, then the absorption of vitamin B 12 changes, and megaloblastic anemia develops. An increase in the level of leukocytes and a high ESR (erythrocyte sedimentation rate) can be interpreted as an exacerbation of the inflammatory process or as the development of Crohn's disease.

Prolongation of prothrombin time indicates vitamin K deficiency

Blood biochemistry allows you to assess the level of albumin, calcium, alkaline phosphatase. With malabsorption, hypokalemia, hypocholesterolemia, and hypoferremia are detected. With constant inflammation in the intestines, the level of C-reactive protein rises. An analysis is also taken to determine the amount of vitamins. The level of serum carotene, cobalamin, folic acid is diagnostically significant.

A lack of vitamin B 12 indicates chronic pancreatitis and pathology of the ileum, a lack of folic acid occurs with celiac disease, tropical sprue, Whipple's disease. If there is excess bacterial growth in the small intestine, then the level of folic acid is above normal, and vitamin B 12 is below normal.

Coprology reveals starch and myocytes in the stool, which indicates a violation of the absorption of carbohydrates and proteins. In some diseases, the pH of feces changes, for example, with disaccharidase deficiency, the result is at least 6.0. A fecal examination is also carried out to determine steatorrhea. Normally, if 93-95% of the incoming fats penetrate into the bloodstream.

With malabsorption of the 2nd degree, the indicator is reduced to 60-80%, with the 3rd degree to 50%. For analysis, feces are collected for three days. Before collecting the material, the patient must adhere to a diet for several days and consume 80-100 grams of fat.

To assess the absorption capacity of the small intestine, a D-xylose test is prescribed. The patient on an empty stomach drinks 25 g of D-xylose and drinks it with a glass of water, after which he collects urine for 5 hours. An hour after taking the substance, blood is taken from a vein. Babies who weigh less than 30 kg should have xylose levels in the blood greater than 25 mg/dl and in the urine no less than 5 g. With malabsorption, renal failure, portal hypertension, ascites, these figures are reduced.

To determine the absorption of vitamin B 12, the Schilling test is prescribed. The patient drinks 1 mcg of the labeled vitamin, and then the laboratory determines how much vitamin was excreted in the urine per day. If less than 5-8%, then this confirms the violation of absorption. This test may be carried out twice to check the effectiveness of the prescribed treatment.

For the treatment of malabsorption, its root cause is important, it is instrumental diagnostic methods that make it possible to identify the pathology that led to the disorder of the absorption or transport function.

Children over 2 years of age may be assigned a stool test for the presence of Giardia.

X-ray with contrast allows you to detect blind loops of the small intestine, anastomoses, diverticula, strictures, ulcers, ulcerations, fistulas, horizontally located levels of gas and liquid, in addition, thickening of the folds of the intestinal mucosa (Wipple's disease, lymphoma, amyloidosis, Zollinger's syndrome- Ellison), atrophy (celiac disease), dilatation of the segments of the small intestine (scleroderma, celiac disease), flattening of the walls (tropical sprue).

Computed tomography will confirm chronic pancreatitis, an increase in mesenteric lymph nodes, pancreatolithiasis, an increase in the diameter of small intestinal loops. Endoscopy is performed if D-xylose is positive or steatorrhea is present. Visual examination allows diagnosing Whipple's disease, amyloidosis, celiac disease, intestinal lymphagioectasia.

During the examination, material for histology is taken, the small intestine contents are aspirated. To confirm the primary disease, other research methods are also carried out, such as an assessment of the exocrine activity of the pancreas, the definition of bacterial overgrowth syndrome, lactase deficiency and celiac disease.

Treatment

After the malabsorption syndrome has been identified, medical measures are taken to eliminate the signs of malabsorption, eliminate the lack of body weight, cure the underlying pathology that provoked the absorption disorder, and prevent the development of complications of malabsorption.

For these purposes, the following measures are taken:

• surgical or medical treatment of the primary disease is carried out;
• the child's nutrition is adjusted taking into account the clinic;
• protein metabolism is restored;
• vitamin deficiency and electrolyte disturbances are eliminated;
• the motility of the intestinal tract is normalized;
• normal intestinal microflora is restored;
• if necessary, rehydration therapy is carried out.

The child is prescribed a diet in which the amount of protein food is increased (up to 130-150 g per day) and the fat content is reduced (with steatorrhea, about two times). The calculation of calories and the qualitative composition of food is carried out taking into account the age norm. Children are assigned specialized mixtures, which contain nutrients in the optimal amount.

The diet also involves the exclusion of foods that cause allergic or inflammatory reactions in the small intestine. So, with lactose intolerance, products containing milk fats are removed from the diet, with celiac disease, gluten should not be consumed. In severe cases, enteral or parenteral nutrition may be prescribed.

In some cases, adherence to a diet is a sufficient measure to eliminate the disorder.

To eliminate the signs of malabsorption, drug therapy is required, with the help of which the mineral balance of the blood is restored and the amount of vitamins is normalized. Vitamin B 12 may be recommended to be administered parenterally. It is prescribed to children at 100 mcg / day for 10-15 days, after which the rate is reduced to 60-100 mcg per month.

Nicotinic acid is usually administered intramuscularly at 0.5 ml, and then the dose is increased by 0.5 ml and given 2 ml for two days, then 3 ml for three days, and so on to 5 ml, then the dosage is reduced. Iron and folic acid are recommended for anemia, they are taken orally until normal blood counts are restored.

Folic acid is prescribed to children at 1 mg per day. Calcium gluconate should be taken 6-12 tablets per day and serum calcium levels should be checked every month. If diagnosed, Whipple, Crohn's, tropical sprue, bacterial overgrowth syndrome, then antibiotic therapy is necessary. The use of antibiotics is indicated for a long time (with tropical sprue, antibiotic therapy is 3-6 months, with Whipple's disease - from a year).

People with Crohn's disease, Whipple's disease, gluten intolerance may be prescribed Prednisolone (hormonal agent)

To reduce intestinal secretion and inhibition of small intestinal motility, Octreotide is used intravenously or subcutaneously (dosage for children 1-10 mcg / kg / day, maximum 1500 mcg per day) or orally Loperamide (children 2-5 years old, 1 mg twice a day, children from 5 years give 2 mg twice a day).

Choleretics are prescribed if malabsorption syndrome is provoked by chronic liver disease or short bowel syndrome. Ursodeoxycholic acid is given to children at the rate of 8-10 mg per kilogram of weight (but not more than 300 mg / day), the dose is divided into two doses. Phenobarbital (3-8 mg/kg) 2-4 times a day may also be recommended.

With pancreatic dysfunction (with Whipple's disease, chronic pancreatitis, cystic fibrosis), enzyme therapy is performed. The dosage is selected individually and depends on the age of the patient and the clinic. Creon, Mezim forte, Pantsitrat can be prescribed. The lack of effect of treatment may be due to increased acidity of gastric juice, in which case it is required to take proton pump inhibitors or H 2 receptor antagonists.

Surgical intervention is carried out only for the pathology that provokes malabsorption syndrome. Surgical intervention may be necessary for Crohn's disease, Hirschsprung disease, liver pathology, complications of inflammation of the large intestine, intestinal lymphangiectasia. The duration of treatment for malabsorption syndrome depends on the primary disease that caused the malabsorption disorder.

If malabsorption has developed against the background of infectious enteritis, then therapy can only consist in treating the underlying disease and dieting for a week, with celiac disease, the diet must be followed for life, and correction of vitamin deficiency and electrolyte balance should be carried out during the entire recovery period (up to six months).

Malabsorption syndrome- a condition in which there is a violation of the absorption of nutrients in the small intestine. Literally, the term "malabsorption" means "poor absorption." Malabsorption occurs at any age, but is especially common in children, due to the immaturity of the gastrointestinal tract, enzyme and immune systems.

Introduction to food absorption and malabsorption syndrome

Nutrients entering the gastrointestinal tract are affected by digestive enzymes (contained in the intestines, gastric juice, pancreatic juice, bile, etc.), as a result, they are broken down into components. Only in this form, nutrient substrates are absorbed into the blood - speaking in "medical language", the small intestine, acting as a selective sieve, allows the absorption of only split products.

Based on this, the causes of malabsorption syndrome can be both diseases of the stomach, pancreas, liver, hereditary enzyme defects that lead to disruption of the digestive process, and diseases of the small intestine itself, leading to a violation of the absorption process.

Causes leading to the development of malabsorption syndrome

Depending on the causes of malabsorption syndrome, it is customary to divide it into primary (congenital, hereditary) and secondary (acquired).

Primary malabsorption syndrome

The cause of the primary malabsorption syndrome, as a rule, is a genetically determined deficiency of a digestive enzyme, or hereditary disorders in the structure of the intestinal wall mucosa.

The most common hereditary diseases that occur with the development of malabsorption syndrome are:

1. Deficiency of the digestive enzyme lactase (lactase deficiency). In this case, malabsorption syndrome is genetically determined by the low activity of the lactase enzyme, which breaks down milk sugar - lactose. This disease is of great importance in early childhood, since lactose is contained in milk, which is the main food of the child.
2. cystic fibrosis- a common hereditary disease in which the glands of the body are affected. The syndrome of malabsorption in the intestinal form of cystic fibrosis develops due to insufficiency of the pancreas and a decrease in the activity of the digestive enzymes secreted by it.
3. . The occurrence of celiac disease is due to intolerance to the components of the cereal protein - prolamine and glutenin (common name - gluten). In genetically predisposed people, under the influence of gluten, inflammation and subsequent atrophy of the intestinal mucosa develop, leading to the development of malabsorption syndrome.
4. Congenital hypoplasia of the pancreas- a malformation in which the pancreas is underdeveloped. Accordingly, the syndrome of malabsorption in this case is due to a lack of pancreatic juice. Manifestations of the disease appear in the first days or weeks of life and intensify when the child is transferred to artificial feeding.

Malabsorption syndrome: secondary forms

Secondary forms of malabsorption in children most often develop in acute intestinal infections and helminthiases (especially giardiasis), dysbacteriosis, and allergic inflammation of the intestine. Rarer causes of secondary malabsorption syndrome in children are removal of the stomach or part of the intestine, diseases of the liver, pancreas, etc.

The main manifestations of malabsorption syndrome

Manifestations of malabsorption syndrome depend on the disease that caused it. The severity of each symptom depends on the degree of nutritional deficiency, as well as on which organ has experienced the greatest violations of biochemical processes.

Common manifestations of malabsorption syndrome include:

• weight loss of the patient or a weak rate of weight gain, growth retardation, poor development of subcutaneous adipose tissue;
• weakness, lack of appetite;
• swelling (as a sign of low protein content in the blood);
• manifestations associated with hypovitaminosis - dry skin, seizures, soreness of the tongue, stomatitis, increased bleeding, increased hair loss, brittle nails, etc .;
• anemia (as a result of insufficient absorption of iron and folic acid);
• with insufficient protein absorption, endocrine disorders may occur (lag in sexual development, menstrual dysfunction, etc.)

On the part of the intestine, manifestations of the syndrome of malabsorption, in the first place, are stool disorders: frequent, profuse diarrhea is characteristic, in which impurities of mucus and foam can be detected. The color of feces changes (from yellow to green), the smell (from sour to fetid).

A manifestation of fat malabsorption is the so-called "fatty stool" - steatorrhea (pale-colored soft stool that sticks to the walls of the toilet or floats and is difficult to wash off). According to the analysis of feces, malabsorption syndrome also reveals creatorrhea (increased content of undigested muscle and connective tissue fibers in the feces), amylorrhea (excretion of an increased amount of undigested starch with feces).

In addition, the characteristic signs of malabsorption in children are anxiety during feeding (intestinal colic), an increase in the size of the abdomen, bloating, rumbling, there may be vomiting, and frequent regurgitation.

In case of any delay in growth and development, it is necessary to show the child to the doctor. Specific tests will help determine which foods or nutrients are not absorbed by the body. In most cases of diseases accompanied by malabsorption syndrome, enzyme replacement therapy and diet provide positive effects.

This condition develops against the background of acute and chronic inflammation of the mucosa of the colon and small intestine and is of an acquired nature. Although the possibility of a primary lesion of the intestine, which is associated with congenital anomalies of its structure and development, is not excluded.

With intracavitary malabsorption, which develops against the background of chronic diseases of the digestive system, the digestion of fats is mainly disturbed. With enterocellular malabsorption, absorption by the cells of the intestinal mucosa is disrupted due to a lack of enzymes of various substances (glucose, galactose, fructose, bile salts, etc.).

It should be noted that the malabsorption syndrome becomes most pronounced some time after the bowel disease, when the main manifestations of the inflammatory process disappear and the child gradually returns to the usual rhythm of life and nutrition.

Symptoms and signs of malabsorption syndrome in children

The main manifestations of this disease are changes in the stool in a sick child. It is the pathological variants of changes in fecal masses that should lead to the idea of ​​malabsorption syndrome.

First of all, the child's stool becomes frequent, sometimes profuse, which can make parents think about exacerbating a recent illness. However, after some time, fecal masses acquire a specific character. Outwardly, they are a grayish shiny mushy mass and, which is very important, with a very unpleasant pungent sour smell. The presence of the luster of feces is easily explained by the presence of undigested fat in them, which, upon close examination, looks like frozen drops. This is a very important sign that will allow you to correctly assess the condition of the child and help the doctor in making a diagnosis.

With malabsorption syndrome, the child is almost completely deprived of all nutrients and minerals, since all of them are excreted undigested from the body along with feces. It is necessary to remember this and not to feed the child with an excess amount of food, especially since overeating does not favorably affect the general condition of the patient and can lead to deterioration. With malabsorption syndrome, the entire intestinal mucosa becomes edematous, inflamed, and the absorption of digestive products is difficult. Additional volumes of food only increase inflammation in the intestines and cause even more swelling of the mucosa.

An important manifestation of malabsorption syndrome is a change in the appearance of a sick child and his behavior. A child suffering from disorders of all types of metabolism (which is expressed in this pathology) cannot fully develop harmoniously. The appearance of such children is very specific: they are pale, lethargic, very thin. Attention is drawn to the pronounced thinning of the subcutaneous fat layer, the sharpening of facial features, which looks haggard. Some children have a waxy pallor (or, as they say, porcelain skin color). The skin of the child is dry to the touch, flabby, easily gathers into a fold, lacks elasticity and peels off in places.

Since the main tissue changes are concentrated in the intestine, it also changes, and this is expressed not only in violation of the function of the organ and metabolic processes, but also manifests itself externally.

The belly of a child suffering from malabsorption syndrome has a characteristic appearance: it is rounded, in some cases it protrudes to the sides and looks disproportionately against the background of thinner limbs. These manifestations develop as a result of severe swelling of the loops of the inflamed intestine.

Violation of the digestion of incoming food leads to the fact that the intestines begin to contract strongly, which is manifested by rumbling and seething in the stomach.

Nails take the form of striated brittle and crumbling plates.

The hair on the scalp thins, splits, breaks when combed, becomes dry and stiff.

Stomatitis can develop on the oral mucosa - a specific disease that is manifested by the formation of ulcers and reddening of the mucosa. Itching, burning and soreness in the mouth make eating excruciatingly painful and even impossible. This further harms the patient's condition, because against the background of a pronounced deficiency of vitamins, all metabolic processes are disrupted, and even nutrition becomes impossible.

Not only the mucous membrane of the mouth becomes inflamed, but also the tongue itself.

It becomes red, edematous, its papillae are smoothed out.

The teeth of a sick child are also changing. The enamel becomes thinner, acquires a transparent or bluish tint, carious cavities quickly and often form in the teeth, which can be hidden: a huge cavity is found under an outwardly small hole.

Deficiency of minerals in the body is manifested primarily by a lack of calcium and fluorine, which is especially reflected in the child's skeletal system. During the period of active growth and knowledge of the world around them, children prefer active games, during which limb fractures may occur. In the course of the disease, they acquire a pathological character, when they occur in a baby even when moving within their own bed.

With a long course of this disease, the child begins to lag behind in growth and development. This is noticeable against the background of his healthy peers, who look more well-fed and tall.

In addition to external parameters, the character of the child and the perception of the surrounding reality change significantly. He becomes nervous, whiny, reacts to various stimuli in the same way: either by crying, or simply indifferently. The child loses a sense of joy, he ceases to experience pleasure from previously pleasant moments and things.

A gloomy, selfish, hysterical personality is formed. These manifestations and changes in character were combined into a single concept: “unfortunate child syndrome”.

Since the food entering the intestines of the patient is not digested and does not undergo final decay, then, in addition to the symptoms of growth retardation and physical development, pronounced manifestations of multivitamin deficiency also join. All vitamins and minerals contained in food, supplements and fortified preparations are not absorbed and are simply excreted from the body in an undigested form with feces. Despite the unsatisfactory condition, the child may continue to want to eat.

Treatment of malabsorption syndrome in children

In this condition, a protective food regimen and a diet are shown, which is compiled for each child individually.

In the treatment, pancreatic enzymes (creon, pancitrate), therapeutic nutritional mixtures (Alfare, Nutrilon-Pepti-TCS, Portagen), preparations for normalizing the composition of the intestinal microflora (bifidumbacterin, lactobacterin), vitamins are used.

Prevention of malabsorption syndrome consists in the treatment of acute and chronic intestinal inflammation in children.

Parents should remember that only the correct and complete treatment of the underlying disease can improve digestion.

Very important in terms of preventing malabsorption syndrome is the diet of the child, especially in early childhood. Pay more attention to the preventive intake and content of vitamins in food.

We must not forget about simple rules, hygienic standards of behavior, we should inspire the child that after visiting public places and the toilet, it is necessary to wash their hands. After all, it is on the hands that pathogens usually accumulate, which cause inflammation of the intestines and stomach.

Violation of the absorption function of the intestine, leading and accompanying severe pathologies, is called malabsorption syndrome. As a result of this disorder, the body does not receive the necessary elements required for normal functioning. The disease is especially dangerous for children, causing a serious delay in maturation and growth in the child.

The concept of "malabsorption" includes a whole group of pathologies that occur in the body due to the complete or partial inability to absorb the necessary substances and elements. This is a condition in which the body is not able to fully develop and function.

The syndrome of malabsorption is also closely related to the syndrome of insufficiency of the digestive function of the gastrointestinal tract (), since in both of these cases a general digestive and absorption dysfunction of various parts of the gastrointestinal tract develops.

Types and forms

Varieties of malabsorption include 2 main groups (forms) according to the type of indigestibility of substances:

1. Selective view, when one element is not absorbed.
2. Total, arising from extensive lesions of the intestine, characterized by a complete lack of digestibility of all elements.

In turn, the forms of malabsorption syndrome (hereinafter referred to as SMA) are divided into varieties according to the type of rejected substance:

1. Protein indigestibility.
2. Disorder of digestion of carbohydrates.
3. Inability to absorb vitamins.
4. Fat intolerance.
5. Malabsorption associated with indigestibility of the mono- and disaccharide group or glucose-galactose. Most often occurs in newborns from the first days of life.
6. Rejection of minerals.
7. Violation of the absorption of amino acids.

Galactose malabsorption in advanced form causes severe consequences in children up to coma and death. However, with timely dietary and drug therapy, the prognosis is quite favorable.

Origin of the syndrome

To provoke the occurrence of malabsorption syndrome in a child can:

Malabsorption is directly related to the nutrition of children. Only a highly qualified doctor can make a diet for your child. If after breastfeeding (milk formula) in an infant or whole milk in an older child there is a general deterioration in the condition, pain, bloating, rumbling, diarrhea - it is worth sounding the alarm. Even one of these symptoms can be an indicator of lactase deficiency.

If the same is observed after the consumption of sugar-containing foods and foods containing galactose and glucose (including sugar, milk, etc.), these are probably manifestations of malabsorption of the glucose-galactose form. Is it possible to drink kefir with HB, read.

Malabsorption syndrome is a serious disease that can lead to severe consequences, including disability, and in some cases even death!

Causes and diseases that provoke pathology

SMA is a multi-causal disease because it has many factors. The occurrence of malabsorption syndrome may be due to congenital and acquired nature:

• A hereditary disease is most often observed in children at the level of intrauterine development, with the occurrence of genetic fermentopathy and congenital anomalies. Hereditary diseases include such severe pathologies as lactase, disaccharide deficiency, celiac disease.
• SMA, provoked by an already existing disease, against which intestinal absorption dysfunction occurs (enteropathy, neoplasms in the small intestine, enteritis, intoxication, unbalanced, malnutrition, systemic diseases).

Diseases that cause malabsorption:

1. Cystic fibrosis (cystofibrosis).
2. Anomalies in development and functioning, neoplasms of the pancreas
3. Foci of inflammation and primary pathologies, allergic and infectious lesions of the intestine.
4. Diarrhea of ​​various nature.
5. Pancreatitis of any kind.
6. Acanthocytosis.
7. Sucrase-isomaltase deficiency.
8. Indigestibility of bile salts.
9. Crohn's disease.
10. Lactase deficiency.
11. rejection of monosaccharides.
12. Deficiency of trypsinogen, enterokinase, duodenase.
13. Cholestasis of any origin.
14. Enterocytic disorders.
15. celiac disease
16. Shwachman-Diamond syndrome.
17. Enteropathy due to immune damage
18. Reducing the suction area.
19. Congenital short intestine.
20. Protein-energy deficiency.
21. Invasive lesions.
22. Syndrome of congestive (blind) intestinal loop.
23. Pathology of the lymphatic and blood vessels.

We offer you to watch a video about the symptoms of one of the most common diseases that cause malabsorption - celiac disease:

Manifestations and degree of development of the disease

Among the common manifestations of malabsorption in childhood, there are:

• diarrhea of ​​an acute and chronic nature, often alternating with constipation (dominant, predominant sign);
• increased gas formation;
• severe symptoms of body dystrophy;
• abdominal pain;
• lag in development and growth;
• loss of appetite;
• manifestations of multivitamin deficiency, disturbances in water and electrolyte balance, are classified according to the type of substance intolerance:

What to do if vomiting occurs in a child, read.

Manifestations of the disease with certain rejected elements:

Depending on the underlying disease, variable symptoms are added to the general manifestations:

1. The syndrome of impaired absorption function against the background of celiac disease is characterized by copious sticky stools, vomiting, dysphagia (swallowing disorders), atopic dermatitis, and allergies.
2. Chronic pancreatitis is manifested by steatorrhea - fatty "soapy" feces with a high content of starch and muscle fibers.
3. Cholestasis (syndrome of violation of bile flow) is characterized by abundant fatty feces with a strong fetid odor.

I want to draw attention to one of the symptoms of malabsorption is diarrhea. No wonder experts around the world consider it dominant. Based on the manifestations of the diarrheal syndrome, it is possible to significantly narrow the parameters of the diagnostic search.

Foamy, acidic stools of a particularly thin consistency are characteristic of galactose malabsorption. Water is possible with protein intolerance to cow's milk, mastocytosis, hereditary adrenal hyperplasia, some types of hormone-producing tumors.

Fatty feces appear in intestinal pathologies, including celiac disease, dysbacteriosis, short intestine, cholepathies. Feces are especially fatty (with characteristic fatty secretions), characteristic of cystic acidosis. Polyfecalia - celiac disease, dermatitis.

The alternation of mushy stools and constipation against the background of neuroses is irritable bowel syndrome. The combination of diarrhea with abdominal pain signals infectious and invasive lesions.

And this is just a small list of varieties of diarrheal disorders. Attentive attitude to this symptom will greatly facilitate the diagnosis.

According to the severity of the lesion, malabsorption syndrome is divided into degrees:
1
Light (1 degree of severity). It manifests itself in the form of symptoms of vitamin deficiency, the child has a slight decrease in body weight (does not exceed 10%), chronic fatigue syndrome (astheno-neurotic), disharmony of general development.
2
Moderate (2 degree). Signs are more pronounced: weight loss reaches 20%, more pronounced symptoms of vitamin, water and electrolyte deficiency, anemic conditions.
3
Severe (3 degree). Weight deficit exceeds 20%, there is a pronounced delay in psychophysical development, obvious symptoms of vitamin and water-electrolyte deficiency, anemic conditions.

Diagnostic measures

Malabsorption syndrome is initially diagnosed on the basis of identifying and summarizing the obvious signs. The clinical picture of the disease in children is specified when the following diagnostic studies are prescribed:

• testing for D-xylose;
• endoscopic and biopsy studies;
• detection of fat and its amount in feces;
• radiography of the small intestine (allowing to identify pathologies of the structure of the organ from a very early age);
• additional testing to confirm the diagnosis.

You can find out what the presence of blood in the feces of a child indicates.

Treatment: methods, goals, principles

The main types of elimination of the malabsorption syndrome are therapeutic and dietary nutrition (the dominant type) and drug adjustment. Rare congenital types of SMA in children may require surgery and specific therapy.

This takes into account:

• type of SMA (hereditary or acquired);
• the degree of violation of the absorption function;
• condition of the digestive tract;
• age, appetite, food preferences and habits;
• level of intestinal sensitivity to osmotic load.

• relief of manifestations of malabsorption;
• restoration of normal body weight;
• elimination of the underlying disease that provoked SMA.

The main principles of treatment:

1. Elimination of the underlying disease that caused malabsorption.
2. Diet therapy.
3. Correction of vitamin-protein metabolism.
4. Correction of violations of water and electrolyte metabolism.
5. Restoration of normal motor function of the digestive tract.
6. Elimination of dysbacteriosis.

Rational nutrition of a newborn is the most important condition that determines the state of health not only in infancy, but also in subsequent life stages. Monitoring the perception of nutrition, its adjustment is especially important in babies with absorptive dysfunction syndrome. So, with glucose-galactose malabsorption, the child needs intravenous administration of glucose along with formula feeding and the addition of a vitamin complex.

Preventive measures are aimed at preventing the disease that provoked the occurrence and development of malabsorption. With high-quality prevention and timely adequate treatment, the prognosis is positive.

Conclusion

Sometimes, SMA is eliminated during dietary therapy and does not require medical adjustment. A huge role in the prevention and treatment of diseases that caused a disorder of the absorption function in a child (especially in the first year of life) is played by his mother. She should eat rationally and fully (when breastfeeding) and observe the reaction of the baby after feeding, inform the doctor about his condition.

In addition, we suggest watching a video on how digestion and absorption of nutrients in the intestine occurs: