Mal-Absorption Syndrome Causes: Clinical Features And Treatment

Mal-Absorption Syndrome Causes: Clinical Features And Treatment . Mal-absorption syndrome includes chronic disorders characterized either by defective digestion or handling of ingested nutrients (mal-digestion) or failure of intestines to absorb them (true mal-absorption). Exact prevalence of different causes of mal-absorption is not known.

By far the common diseases occurring in tropical countries, are tropical sprue, followed by tuberculosis, lymphoma of IPSID (immuno-proliferative small intestinal disease) and in children, giardiasis is a common problem.

Other causes include.

Mal-digestion

• Defective pancreatic secretion as in:

• Chronic pancreatitis
• Pancreatic cancer
• Pancreatic resection cystic fibrosis

• Lactase deficiency as in:

• Luminal physio-chemical defects
• Inadequate mixing (post gastrectomy)
• Congenital enterokinase deficiency
• Hepato-cellular diseases

Mal-absorption

• Mucosal disease

• Tropical sprue
• Celiac sprue
• Inflammation due to giardiasis, tuberculosis, lymphoma and other gastrointestinal malignancies.
  
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• Intra-luminal defects

• Bacterial overgrowth syndrome

• Endocrine defects

• Diabetes mellitus
• Hypo-parathyroidism
• Thyrotoxicosis
• Addison’s disease

• Short bowel syndrome and segmental resections of terminal ileum.
• Drug induced enteropathy – neomycin and colchicines.
• Lymphatic obstruction
  • Due to retro-peritoneal tumor or fibrosis and lymphoma.

• Vascular disease (mesenteric insufficiency).
• Genetic defects
  • Single enzyme defects leading to mal-absorption of amino acids, minerals, vitamins, fats and sugars.
• Systemic diseases
  • Amyloidosis
  • Protein malnutrition
  • Eosinophilic gastroenteritis
  • Collagen disorders
• Miscellaneous diseases
  • Whipple’s disease
  • Collagenous sprue
  • Intestinal pseudo-obstruction
  • Gut mal-rotation

Clinical Features Of Malabsorption Syndrome

Person suffering from malabsorption syndrome may present with symptoms of underlying disease or with symptoms which occur irrespective of the cause of malabsorption. Symptoms which suggest malabsorption regardless of its cause can be grouped as below.

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• Steatorrhoea: It is passage of pale, loose, bulky, greasy offensive smelling stool that is difficult to flush from toilet pan. This classical pattern of stool may become less prominent and be absent if the patient reduces the consumption of dietary fat. Excess and bulky stool may pass with lesions in small intestine or large intestine.
• Diarrhea: The stools are large and watery. There is excessive flatulence and floating of stools which suggests carbohydrate malabsorption. The stools are often offensive.
• Abdominal symptoms: There is colicky pain and abdominal discomfort. Sometimes the symptoms may be related to meals or defecation.
• Nutritional deficiency: Long standing malabsorption syndrome may lead to vitamin and mineral deficiency. Anemia, bleeding due to vitamin K deficiency is present. Weight loss, swelling in legs and face, wasting of muscles, night blindness, neurological problems appear due to vitamin A, B and protein malabsorption.

Treatment For Malabsorption Syndrome

Depending on the diagnosis, it is possible to institute specific treatment for malabsorption syndrome. Patient may have to eliminate gluten containing preparations. If lactose intolerance is detected, he may have to eat lactose free diet.

Treating infections and inflammation in intestine may be sought if it is the cause. Patient may also need administration of pancreatic enzyme. Antibiotics may be necessary in presence of excess of bacterial overgrowth. Symptomatic treatment may be required for nutritional support.

Patient should avoid eating foods rich in fats. He has to stop eating fried and spicy food. He should eat high protein diet, which usually is well tolerated. Vitamin and mineral supplements are essential. Certain foods should be avoided or taken in smaller portions they are spinach, beet, peanuts, beans, carrots, onions, chocolates, tea, coffee, and cola.