Malabsorption (malabsorption syndrome): what is it, symptoms, causes, treatment, diagnosis, prevention, diet

Syndrome of malabsorption in the intestine or malabsorption syndrome - a gastrointestinal disease, as a result development of which the process of digestion of products is disrupted, obtaining nutritious components. In addition, further transportation of processed food through the small intestine is disrupted. This leads to a change in the metabolic process, vitamin deficiency and other unpleasant consequences, therefore it is important to timely identify the pathology and start treating it.

What is the small intestine malabsorption syndrome?

Malabsorption syndrome is accompanied by a complex of symptoms associated with intestinal digestive failure. There are several forms of pathology, some of which have pronounced symptoms and lead to serious complications. To avoid this, it is important to start competent treatment of malabsorption syndrome in the small intestine as early as possible.

In children, malabsorption is diagnosed more often than in adults and has a more severe course.

Diseases are classified according to various criteria:

1. Based on what became its cause, primary and secondary malabsorption in the small intestine is isolated. In the secondary form, malabsorption was the result of background pathology.
2. The disease can be congenital or acquired. In 10% of cases, doctors diagnose a congenital pathology. In the rest, it is an acquired syndrome that can appear several weeks after birth or within 10 years.
3. According to the degree of development, mild, moderate and severe degrees of malabsorption in the small intestine are distinguished.

Separately, iatrogenic malabsorption, which is of artificial origin, is isolated. Usually, the surgical intervention, which provokes the violation, is carried out with the aim of treating morbid obesity.

Causes of malabsorption

There are many known causes of malabsorption in the small intestine. The primary pathology may be associated with genetic enzymopathy, in which a person has glucose-lactase deficiency, fructose intolerance, impaired absorption of vitamin B12, folic acid, amino acids.

Secondary malabsorption syndrome develops against the background of internal pathologies, in particular, with a malfunction of the thyroid gland. But, in most cases, the cause is gastrointestinal diseases (colitis, gastritis, enteritis etc.).

Violation can be provoked by:

• dysbiosis;
• violation of blood circulation in the intestine;
• the presence of a neoplasm in the intestine;
• damage to the digestive system from medications or chemicals;
• violation of peristalsis;
• a change in the composition of bile, in which there are too few bile salts;
• atrophic processes in the gastrointestinal tract;
• deficiency of digestive enzymes;
• some parasitic diseases.

Malabsorption symptoms

Symptoms of malabsorption syndrome in the small intestine are closely related to malabsorption of nutrients and vitamins. Diarrhea is the main symptom of malabsorption. At first, it occurs periodically, but over time it becomes constant. In this case, the frequency of the stool does not exceed 6 times a day. It has a pungent odor and can be watery or mushy.

Symptoms indicate the disease:

1. Increased gas formation. In this case, a person often complains about the release of fetid gases.
2. Abdominal pain. Most often occurs on the left, but may be shingles or radiate to the lumbar region. If a person has lactase deficiency, then the pain has a cramping character.
3. Discoloration of feces, their excessive fat content. It is associated with cholestasis or malabsorption of fatty acids.
4. Dryness of the skin and other lesions of the dermis (hyperpigmentation, eczema, dermatitis) occurring against the background of vitamin deficiency.
5. Brittleness, hair loss.
6. Subcutaneous hemorrhage or the appearance of red spots on the body due to a deficiency of vitamin K in the body.
7. Night blindness associated with a lack of vitamin A.
8. Damage to the nervous system (neuropathy, paresthesia), arising against the background of a deficiency of vitamins E, B1.
9. Vitamin B12 deficiency anemia.
10. Ascites, peripheral edema, the cause of which is a decrease in the concentration of protein in the blood, an imbalance of electrolytes.
11. Weight loss, up to extreme exhaustion.
12. Decreased levels of sex hormones, other endocrine disorders.
13. Drowsiness, muscle weakness, fatigue.
14. Constant thirst.

Diagnostics of the malabsorption syndrome

To determine the syndrome of malabsorption in the small intestine, the doctor prescribes a comprehensive diagnosis, which includes:

1. Collecting anamnesis. The doctor will inquire about the time of onset of symptoms, the severity and characteristics of their manifestation. Additionally, a family history is studied to identify close relatives who suffer from Crohn's disease or other gastrointestinal pathologies.
2. General examination, which consists in palpation of the abdomen, assessment of the condition of the skin, nail plates, hair.
3. Blood test. The analysis allows you to assess the level of hemoglobin and erythrocytes, to identify abnormalities in the body, inflammatory processes.
4. Stool examination for parasitic infections, occult blood.
5. Ultrasound - assesses the condition of the abdominal organs.
6. Esophagogastroduodenoscopy - examination of the inner surface of the stomach and duodenum. If necessary, a sample is taken for a biopsy.
7. Colonoscopy - allows you to assess the condition of the colon and take a biopsy.
8. Irrigoscopy - examination of the large intestine using X-ray equipment.
9. Sigmoidoscopy - examination of the rectum and sigmoid colon using an endoscope.
10. X-rays of bones can be used to determine their density. This is necessary in order to identify the lack of minerals responsible for the condition of the bone tissue.
11. CT is performed for a comprehensive assessment of the condition of all internal organs. This is one of the few diagnostic methods that helps to identify neoplasms at various stages of their development.
12. MRI - the most informative method that allows you to assess the state of internal organs.
13. Functional tests (D-xylose test, Schilling test) to detect gastritis, duodenitis and other pathologies of the gastrointestinal tract.

Treatment of malabsorption in the small intestine

Malabsorption syndrome requires a comprehensive approach to treatment. After the diagnosis is made, the doctor will prescribe medications and diet. If the malabsorption in the small intestine is secondary, then additional therapy will be prescribed for concomitant pathology, which became the cause of the development of the disease. In some cases, surgery is indicated.

Medical treatment for malabsorption

The prescription of specific medications depends on the cause of the development of the disease and the characteristics of its course. Special attention is paid to vitamin therapy. The patient is prescribed vitamin and mineral complexes, which necessarily include:

• calcium;
• B vitamins;
• iron.

Sometimes patients require antibiotic therapy. A suitable drug is selected based on which pathogen caused the development of malabsorption. For example, with excessive bacterial growth, Rifaximin is prescribed, and with tropical sprue (post-infectious pathology) - Doxycycline or other tetracycline antibiotics. The duration of taking antibacterial drugs is determined individually for each person.

If the patient is diagnosed with Crohn's disease, celiac disease or Whipple's disease - hormonal medications are required. Most often, they are advised to take Prednisolone or other glucocorticosteroids.

Malabsorption syndrome is always accompanied by diarrhea, so patients are prescribed Imodium or Loperamide. The dosage is determined by the doctor, but usually 1 tablet is taken after each bowel movement, but no more than 6 during the day.

With short bowel syndrome or chronic liver pathologies, therapy is supplemented with cholinergics. The most popular drug in this group is Ursofalk. The dosage depends on the age and weight of the patient.

If the malabsorption in the small intestine is caused by a pancreatic insufficiency, digestive enzymes are used:

• Mezim Forte;
• Creon;
• Pancreatin.

To exclude the development of ulcers, antacids are used (Famotidine, Ranitidine, Kvamatel), which help to inhibit the production of hydrochloric acid in the stomach. Additionally, proton pump inhibitors are prescribed - Nexium, Omez.

Diet

Treatment of the syndrome of malabsorption in the intestine is impossible without normalization of nutrition. The choice of diet depends on what caused the malabsorption. In doing so, it is important to increase the amount of protein in the diet and reduce the intake of fat.

In case of hypoproteinemia, patients are shown enteral nutrition with the use of special mixtures. In order for them to be fully assimilated, their introduction is carried out using a probe. In severe cases, in case of malabsorption in the intestine, parenteral nutrition is used.

Surgical intervention

In extreme cases, if it is impossible to cure the malabsorption syndrome in the small intestine with conservative methods, the doctor recommends surgical intervention. Usually, the operation is performed when:

• NNC;
• Crohn's disease;
• intestinal lymphangiectasia.

Prevention of malabsorption syndrome

To avoid the occurrence of malabsorption syndrome, doctors advise adhering to preventive rules:

1. Monitor your diet, eat balanced. The food should have enough vitamins and minerals.
2. Strengthen immunity.
3. If necessary, take vitamin and mineral complexes or enzymatic preparations.
4. To refuse from bad habits.
5. Annually undergo a medical examination, treat diseases that can cause the development of malabsorption in the small intestine.

Malabsorption syndrome is a disease characterized by impaired absorption of certain nutrients in the small intestine. It can be congenital or occur during life. The main treatment is a special diet and medication.

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Malabsorption - lecture.

Sources:

• https://cyberleninka.ru/article/n/sindrom-malabsorbtsii-klinicheskie-sluchai-iz-ambulatornoy-praktiki 
• https://ggptknhp.by/gastroenterologiya/sindrom-malabsorbtsii-chto-eto-takoe-lechenie-bolezni-i-ee-profilaktika.html
• https://xn--90ad9d.xn--p1ai/bolezni-kishechnika/chto-takoe-sindrom-malabsorbtsii.html
• https://ggptknhp.by/gastroenterologiya/sindrom-malabsorbtsii-chto-eto-takoe-lechenie-bolezni-i-ee-profilaktika.html