Malabsorption syndrome

Malabsorption syndrome

Malabsorption syndrome may be due to a lack of any stage of digestion or pathology of any of the organs of the gastrointestinal tract.

Etiology

• • Hypervitaminosis and hypovitaminosis E
  • Glucose and galactose malabsorption syndrome (*182380, 22ql3.1, transmembrane sodium glucose transporter gene SLC5A1, p).

Clinical manifestations are different, because. malabsorption may involve one or more nutrients

• • Changed fetid feces, on the plane of the water in the toilet one can observe films of fat or drops of oil
  • Weight loss
  • Edema and ascites secondary to hypoalbuminemia
  • Secondary anemia due to malabsorption of iron, vitamin B12, folic acid, or a combination
  • Bone pain or fractures due to vitamin D deficiency
  • Paresthesia or tetany due to calcium deficiency
  • Bleeding due to vitamin K deficiency
  • Neuropathy and other manifestations of hypovitaminosis E
  • Muscle weakness due to potassium deficiency.

Diagnosis is based on clinical findings and confirmed by laboratory tests.

• • Analysis of fat content in feces. A positive Sudan stain indicates faecal excretion of more than 15 g of fat per day. The fat content is determined in 72-hour stool samples. Normally, 93-95% of dietary fats are absorbed. Pancreatic disease is often associated with fat excretion in excess of 20-30 g/day.
  • The xylose absorption test, which does not require enzymatic digestion or micelle formation for absorption, is used to assess the integrity of the intestinal mucosa. Take 25 g orally. Urine collected over 5 hours should contain at least 4–5 g of rf-xylose.
  • Test for unabsorbed carbohydrates. The entry of unabsorbed carbohydrates into the large intestine and their fermentation by bacteria lowers the pH of the feces; the condition is especially common with a lack of lactase, as well as with celiac disease and short bowel syndrome.
  • Study of the functions of the pancreas. The content of bicarbonate and total excretion of fluid from the duodenum after stimulation with secretin, followed by the use of pancreatic chymotrypsin (bentyramide test) to release para-aminobenzoic acid excreted in the urine; urinary excretion less than 60% suggests pancreatic insufficiency.
  • Measurement of the level of carotene in the blood. Vitamin A is fat-soluble, and the level of carotene is determined by the metabolism of the vitamin; low serum carotene levels with normal vitamin A intake may be informative in assessing fat malabsorption.
  • Bacteria growth
  • Culture of jejunal aspirates. Deviation from the norm: >10< microorganisms / ml. It is safe to assume dysbacteriosis in the presence of obligate anaerobes (clostridia and bacteroids), facultative anaerobes (lactobacilli and enterococci), or bacteria of the intestinal group.
  • Breath tests for the presence of bile salts are based on the likelihood of bacteria deconjugating mC-labeled glycine cholate before it can be absorbed. Then |4C-glycine is transformed into HC02, and its content is measured in the exhaled air of the diseased in order to detect excessive growth of bacteria.
  • Test for indican and 5-hydroxyindoleacetic acid in urine: the increased content is due to an increase in the metabolism of tryptophan; the test is non-specific, because changes in the levels of tryptophan metabolites are also detected in carcinoid syndrome and Upppa’s disease.
  • X-ray of the small intestine is an informative diagnostic method, especially when contrasting with air. Deposit

or barium flocculation suggests celiac disease. Thickened folds are observed in Whipple’s disease, lymphoma, amyloidosis, radiation enteritis, Zominger-Ellison syndrome, and eosinophilic enteritis.

• • Schilling’s excretory test. Used to diagnose malabsorption of vitamin B12. The first stage of the Schilling test is the intake of 57Co-labeled vitamin B12 with subsequent determination of urine radioactivity. The second stage is the repetition of the test after the introduction of the internal factor. Incomplete urine collection is a common underlying cause of low results, so a plasma radioisotope test is performed at the same time. Low levels in blood plasma and urine suggest a decrease in absorption. Normalization of the results after the second stage of the test indicates the present. such as pernicious anemia and intrinsic factor deficiency. Low levels of the second stage excretory test are often due to severe celiac disease, bacterial overgrowth, resection, or inflammation of the terminal ileum where absorption occurs.
  • Biopsy of the small intestine. Flattening of the villi with infiltration by inflammatory cells is characteristic of celiac disease, isolated flattening of the villi is observed in infectious enteritis, giardiasis, lymphoma, and bacterial overgrowth.

Treatment tactics for specific causes of malabsorption

• • Pancreatic insufficiency occurs with chronic pancreatitis, pancreatic carcinoma, cystic fibrosis. There may be changes in samples with bentyramide or secretin (study of pancreatic function). Perform pancreatic enzyme replacement therapy
  • Bacterial overgrowth accompanies changes in peristalsis (eg, in diabetes mellitus and amyloidosis), diverticula of the small intestine, strictures (eg, in lymphoma and Crohn’s disease), or the formation of blind loops after Bimroth-P gastrectomy. Antibacterial therapy with ampicillin or tetracycline is often successful, surgical correction of anatomical changes is possible
  • Celiac disease – see Tse/shakia
  • Whipple’s disease – see Whipple’s disease.

ICD. K90 Malabsorption in the intestine Literature. 336:371-376