Malabsorption
Malabsorption |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]
Overview
Malabsorption is a condition which is associated with impaired absorption of one or all dietary nutrients. There are multiple etiologies with diminished intestinal absorption. Many of them present with diarrhea, especially steatorrhea. They might have malabsorption of carbohydrates, fat, protein, vitamins, and/or minerals. Malabsorption is occurred following intestinal mucosal or structural defects. Malabsorption according to etiology may be classified into five main groups including infection, structural defect, digestive failure, systemic disease, and iatrogenic causes. Different workups might be used to differentiate diagnosis of malabsorption including small bowel biopsy, stool exam, breath testings, lab findings, and imagings.
Classification
Malabsorption according to etiology may be classified into five main groups:[1][2]
Malabsorption classification | |
---|---|
Infection | |
Viral | HIV |
Bacterial | Tuberculosis |
Tropical sprue | |
Whipple's disease | |
Small intestinal bacterial overgrowth syndrome | |
Parasitic | Giardia |
Isospora | |
Structural or enzyme defect | |
Blind loop syndrome | |
Fistula | |
Diverticula | |
Stricture | |
Lactase deficiency | |
Digestive failure | |
Pancreatic insufficiency | Cystic fibrosis |
Chronic pancreatitis | |
Pancreatic cancer | |
Zollinger–Ellison syndrome | |
VIPoma | |
Carcinoid syndrome | |
Bile acid malabsorption | |
Systemic disease | |
Celiac disease | |
Inflammatory bowel disease | Crohn's disease |
Ulcerative colitis | |
Infiltrative disorders | Amyloidosis |
Lymphoma | |
Eosinophilic gastroenteritis | |
Endocrine abnormalities | Diabetes mellitus |
Hypothyroidism | |
Hyperthyroidism | |
Hyperparathyroidism | |
Hypoparathyroidism | |
Addison's disease | |
Immunologic disorders | Common variable immunodeficiency |
Abetalipoproteinemia | |
Iatrogenic | |
Medication | |
Radiation | |
Post surgery | Gastrectomy |
Bariatric surgery | |
Short bowel syndrome |
Differentiating malabsorption from other Diseases
To review the differential diagnosis of diarrhea, click here.
The following table outlines the major differential diagnoses of malabsorption.[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]
Categories | Cause | Clinical manifestation | Lab findings | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Symptoms | Findings | |||||||||||||||
Duration | Diarrhea | Fever | Abdominal pain | Weight loss | ||||||||||||
Stool exam | CBC | |||||||||||||||
Acute | Chronic | Watery | Bloody | Fatty | WBC | Hgb | Plt | |||||||||
Gastrointestinal | Crohn's disease | – | + | + | + | + | ± | + | + | WBC +
RBC + |
↑ | ↓ | ↑ | |||
Ulcerative colitis | – | + | + | + | + | ± | + | + |
|
WBC +
RBC + |
↑ | ↓ | ↑ | |||
Celiac disease | – | + | ± | – | ± | – | + | + |
|
Fat droplets on sudan stain | Nl | ↓ | Nl | |||
Cause | Duration | Diarrhea | Fever | Abdominal pain | Weight loss | Findings | Stool exam | CBC | ||||||||
Acute | Chronic | Watery | Bloody | Fatty | WBC | Hgb | Plt | |||||||||
Cystic fibrosis | – | + | – | – | + | ± | + | + | Fat droplets on sudan stain | Nl | ↓ | Nl | ||||
Chronic pancreatitis | – | + | + | – | + | – | + | + | Fat droplets on sudan stain
Fecal elastase + |
Nl | Nl | Nl | ||||
Bile acid malabsorption | – | + | + | – | + | – | – | + | Fat droplets on sudan stain | Nl | Nl | Nl | ||||
Lactose intolerance | + | + | + | – | – | – | + | – | – | Nl | Nl | Nl | ||||
Infection | Bacterial | Cause | Duration | Diarrhea | Fever | Abdominal pain | Weight loss | Findings | Stool exam | CBC | ||||||
Acute | Chronic | Watery | Bloody | Fatty | WBC | Hgb | Plt | |||||||||
Whipple's disease | – | + | + | – | + | ± | + | + | Fecal fat + | ↓ | ↓ | ↓/↑ | ||||
Tropical sprue | + | + | + | – | + | + | + | + |
|
WBC + | Nl | ↓ | Nl | |||
Small bowel bacterial overgrowth | – | + | + | – | + | – | + | + | WBC + | Nl | ↓ | Nl | ||||
Cause | Duration | Diarrhea | Fever | Abdominal pain | Weight loss | Findings | Stool exam | CBC | ||||||||
Acute | Chronic | Watery | Bloody | Fatty | WBC | Hgb | Plt | |||||||||
Virus | HIV | – | + | + | – | – | + | + | + |
|
WBC + | ↓ | ↓ | Nl | ||
Parasite | Giardia | – | + | + | – | + | – | + | + | Ova + | Nl | Nl | Nl | |||
Isospora | + | + | + | – | + | + | + | + | WBC +
RBC + Ova + |
↑ | Nl | Nl | ||||
Tumors | VIPoma | + | + | + | – | + | – | + | + | – | Nl | Nl | Nl | |||
Zollinger–Ellison syndrome | – | + | + | + | + | – | + | + | – | Nl | ↓ | Nl | ||||
Cause | Duration | Diarrhea | Fever | Abdominal pain | Weight loss | Findings | Stool exam | CBC | ||||||||
Acute | Chronic | Watery | Bloody | Fatty | WBC | Hgb | Plt | |||||||||
Lymphoma | – | + | + | + | – | + | + | + | RBC + | Nl | ↓ | Nl | ||||
Medication/Toxicity | + | + | + | – | ± | ± | + | + | – | ↑ | Nl | Nl | ||||
Iatrogenic | Short bowel syndrome | + | + | + | – | + | – | – | + |
|
Fecal fat + | Nl | ↓ | ↑ | ||
Radiation enteritis | + | + | + | + | + | – | + | + |
|
WBC +
RBC + |
Nl | ↓ | Nl | |||
Others | Cause | Duration | Diarrhea | Fever | Abdominal pain | Weight loss | Findings | Stool exam | CBC | |||||||
Acute | Chronic | Watery | Bloody | Fatty | WBC | Hgb | Plt | |||||||||
Abetalipoproteinemia | – | + | + | – | + | – | + | + | – | Nl | Nl | Nl | ||||
Hyperthyroidism | – | + | + | – | – | ± | + | + |
|
Fecal fat + | Nl | Nl | Nl | |||
Diabetic neuropathy | – | + | + | – | + | – | + | + | Fecal fat + | Nl | ↓ | Nl | ||||
Systemic sclerosis | – | + | + | ± | + | – | + | + | RBC + | Nl | ↓ | Nl |
References
- ↑ Papadia C, Di Sabatino A, Corazza GR, Forbes A (2014). "Diagnosing small bowel malabsorption: a review". Intern Emerg Med. 9 (1): 3–8. doi:10.1007/s11739-012-0877-7. PMID 23179329.
- ↑ Freeman HJ (2000). "Small intestinal mucosal biopsy for investigation of diarrhea and malabsorption in adults". Gastrointest. Endosc. Clin. N. Am. 10 (4): 739–53, vii. PMID 11036541.
- ↑ Casburn-Jones, Anna C; Farthing, Michael Jg (2004). "Traveler's diarrhea". Journal of Gastroenterology and Hepatology. 19 (6): 610–618. doi:10.1111/j.1440-1746.2003.03287.x. ISSN 0815-9319.
- ↑ Kamat, Deepak; Mathur, Ambika (2006). "Prevention and Management of Travelers' Diarrhea". Disease-a-Month. 52 (7): 289–302. doi:10.1016/j.disamonth.2006.08.003. ISSN 0011-5029.
- ↑ Pfeiffer, Margaret L.; DuPont, Herbert L.; Ochoa, Theresa J. (2012). "The patient presenting with acute dysentery – A systematic review". Journal of Infection. 64 (4): 374–386. doi:10.1016/j.jinf.2012.01.006. ISSN 0163-4453.
- ↑ Barr W, Smith A (2014). "Acute diarrhea". Am Fam Physician. 89 (3): 180–9. PMID 24506120.
- ↑ Amil Dias J (2017). "Celiac Disease: What Do We Know in 2017?". GE Port J Gastroenterol. 24 (6): 275–278. doi:10.1159/000479881. PMID 29255768.
- ↑ Kotloff KL, Riddle MS, Platts-Mills JA, Pavlinac P, Zaidi A (2017). "Shigellosis". Lancet. doi:10.1016/S0140-6736(17)33296-8. PMID 29254859. Vancouver style error: initials (help)
- ↑ Yamamoto-Furusho, J.K.; Bosques-Padilla, F.; de-Paula, J.; Galiano, M.T.; Ibañez, P.; Juliao, F.; Kotze, P.G.; Rocha, J.L.; Steinwurz, F.; Veitia, G.; Zaltman, C. (2017). "Diagnóstico y tratamiento de la enfermedad inflamatoria intestinal: Primer Consenso Latinoamericano de la Pan American Crohn's and Colitis Organisation". Revista de Gastroenterología de México. 82 (1): 46–84. doi:10.1016/j.rgmx.2016.07.003. ISSN 0375-0906.
- ↑ Borbély, Yves M; Osterwalder, Alice; Kröll, Dino; Nett, Philipp C; Inglin, Roman A (2017). "Diarrhea after bariatric procedures: Diagnosis and therapy". World Journal of Gastroenterology. 23 (26): 4689. doi:10.3748/wjg.v23.i26.4689. ISSN 1007-9327.
- ↑ Crawford, Sue E.; Ramani, Sasirekha; Tate, Jacqueline E.; Parashar, Umesh D.; Svensson, Lennart; Hagbom, Marie; Franco, Manuel A.; Greenberg, Harry B.; O'Ryan, Miguel; Kang, Gagandeep; Desselberger, Ulrich; Estes, Mary K. (2017). "Rotavirus infection". Nature Reviews Disease Primers. 3: 17083. doi:10.1038/nrdp.2017.83. ISSN 2056-676X.
- ↑ Kist M (2000). "[Chronic diarrhea: value of microbiology in diagnosis]". Praxis (Bern 1994) (in German). 89 (39): 1559–65. PMID 11068510.
- ↑ Guerrant RL, Shields DS, Thorson SM, Schorling JB, Gröschel DH (1985). "Evaluation and diagnosis of acute infectious diarrhea". Am. J. Med. 78 (6B): 91–8. PMID 4014291.
- ↑ López-Vélez R, Turrientes MC, Garrón C, Montilla P, Navajas R, Fenoy S, del Aguila C (1999). "Microsporidiosis in travelers with diarrhea from the tropics". J Travel Med. 6 (4): 223–7. PMID 10575169.
- ↑ Wahnschaffe, Ulrich; Ignatius, Ralf; Loddenkemper, Christoph; Liesenfeld, Oliver; Muehlen, Marion; Jelinek, Thomas; Burchard, Gerd Dieter; Weinke, Thomas; Harms, Gundel; Stein, Harald; Zeitz, Martin; Ullrich, Reiner; Schneider, Thomas (2009). "Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas". Scandinavian Journal of Gastroenterology. 42 (3): 391–396. doi:10.1080/00365520600881193. ISSN 0036-5521.
- ↑ Mena Bares LM, Carmona Asenjo E, García Sánchez MV, Moreno Ortega E, Maza Muret FR, Guiote Moreno MV, Santos Bueno AM, Iglesias Flores E, Benítez Cantero JM, Vallejo Casas JA (2017). "75SeHCAT scan in bile acid malabsorption in chronic diarrhoea". Rev Esp Med Nucl Imagen Mol. 36 (1): 37–47. doi:10.1016/j.remn.2016.08.005. PMID 27765536.
- ↑ Gibson RJ, Stringer AM (2009). "Chemotherapy-induced diarrhoea". Curr Opin Support Palliat Care. 3 (1): 31–5. doi:10.1097/SPC.0b013e32832531bb. PMID 19365159.
- ↑ Abraham BP, Sellin JH (2012). "Drug-induced, factitious, & idiopathic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 633–48. doi:10.1016/j.bpg.2012.11.007. PMID 23384808.
- ↑ Reintam Blaser A, Deane AM, Fruhwald S (2015). "Diarrhoea in the critically ill". Curr Opin Crit Care. 21 (2): 142–53. doi:10.1097/MCC.0000000000000188. PMID 25692805.
- ↑ McMahan ZH, DuPont HL (2007). "Review article: the history of acute infectious diarrhoea management--from poorly focused empiricism to fluid therapy and modern pharmacotherapy". Aliment. Pharmacol. Ther. 25 (7): 759–69. doi:10.1111/j.1365-2036.2007.03261.x. PMID 17373914.
- ↑ Schiller LR (2012). "Definitions, pathophysiology, and evaluation of chronic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 551–62. doi:10.1016/j.bpg.2012.11.011. PMID 23384801.
- ↑ Giannella RA (1986). "Chronic diarrhea in travelers: diagnostic and therapeutic considerations". Rev. Infect. Dis. 8 Suppl 2: S223–6. PMID 3523719.
- ↑ Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR; et al. (2005). "Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology". Can J Gastroenterol. 19 Suppl A: 5A–36A. PMID 16151544.
- ↑ Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D (2002). "Bowel habits and bile acid malabsorption in the months after cholecystectomy". Am J Gastroenterol. 97 (7): 1732–5. doi:10.1111/j.1572-0241.2002.05779.x. PMID 12135027.
- ↑ Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R; et al. (1991). "Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia". Gastroenterology. 100 (2): 359–69. PMID 1702075.
- ↑ RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC (1960). "Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue". Gastroenterology. 38: 28–49. PMID 14439871.
- ↑ Konvolinka CW (1994). "Acute diverticulitis under age forty". Am J Surg. 167 (6): 562–5. PMID 8209928.
- ↑ Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006). "The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications". Gut. 55 (6): 749–53. doi:10.1136/gut.2005.082909. PMC 1856208. PMID 16698746.
- ↑ Haque R, Huston CD, Hughes M, Houpt E, Petri WA (2003). "Amebiasis". N Engl J Med. 348 (16): 1565–73. doi:10.1056/NEJMra022710. PMID 12700377.
- ↑ Hertzler SR, Savaiano DA (1996). "Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance". Am J Clin Nutr. 64 (2): 232–6. PMID 8694025.
- ↑ Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC (1997). "Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect?". Gut. 41 (5): 632–5. PMC 1891556. PMID 9414969.
- ↑ BLACK-SCHAFFER B (1949). "The tinctoral demonstration of a glycoprotein in Whipple's disease". Proc Soc Exp Biol Med. 72 (1): 225–7. PMID 15391722.