Malabsorption 

  • Author: Jan-Michael A Klapproth, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Jan 5, 2012
 

Background

Malabsorption is a clinical term that encompasses defects occurring during the digestion and absorption of food nutrients by and infections of the gastrointestinal tract. The digestion or absorption of a single nutrient component may be impaired, as in lactose intolerance due to lactase deficiency. When a diffuse disorder, such as celiac disease or Crohn's disease, affects the intestine, the absorption of almost all nutrients is impaired.

Although presenting symptoms, such as diarrhea and weight loss, may be common, the specific causes of malabsorption are usually established based on physiologic evaluations. The treatment often depends on the establishment of a definitive etiology for malabsorption.

Next

Pathophysiology

To understand the mechanisms of malabsorption, understanding the normal physiologic process of digestion and absorption by the intestinal tract is necessary.

In general, the digestion and absorption of food materials can be divided into 3 major phases: luminal, mucosal, and postabsorptive.[1] The luminal phase is the phase in which dietary fats, proteins, and carbohydrates are hydrolyzed and solubilized by secreted digestive enzymes and bile. The mucosal phase relies on the integrity of the brush-border membrane of intestinal epithelial cells to transport digested products from the lumen into the cells. In the postabsorptive phase, reassembled lipids and other key nutrients are transported via lymphatics and portal circulation from epithelial cells to other parts of the body.

Perturbation by disease processes in any of these phases frequently results in malabsorption.

Previous
Proceed to Clinical Presentation
 
 
Contributor Information and Disclosures
Author

Jan-Michael A Klapproth, MD  Assistant Professor, Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine

Jan-Michael A Klapproth, MD is a member of the following medical societies: American College of Gastroenterology, American Federation for Medical Research, American Gastroenterological Association, and Crohns and Colitis Foundation of America

Disclosure: Nothing to disclose.

Coauthor(s)

Vincent W Yang, MD, PhD  R Bruce Logue Professor, Director, Division of Digestive Diseases, Department of Medicine, Professor of Hematology and Oncology, Winship Cancer Institute, Emory University School of Medicine

Vincent W Yang, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, American Society for Clinical Investigation, and Association of American Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Tushar Patel, MB, ChB  Professor of Medicine, Ohio State University Medical Center

Tushar Patel, MB, ChB is a member of the following medical societies: American Association for the Study of Liver Diseases and American Gastroenterological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Douglas M Heuman, MD, FACP, FACG, AGAF  Chief of GI, Hepatology, and Nutrition at North Shore University Hospital/Long Island Jewish Medical Center; Professor, Department of Medicine, Hofstra North Shore-LIJ School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association

Disclosure: Novartis Grant/research funds Other; Bayer Grant/research funds Other; Otsuka Grant/research funds None; Bristol Myers Squibb Grant/research funds Other; Scynexis None None; Salix Grant/research funds Other; MannKind Other

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

  1. Owens SR, Greenson JK. The pathology of malabsorption: current concepts. Histopathology. Jan 2007;50(1):64-82. [Medline].

  2. Holt PR. Diarrhea and malabsorption in the elderly. Gastroenterol Clin North Am. Jun 2001;30(2):427-44. [Medline].

  3. Potter GD. Bile acid diarrhea. Dig Dis. Mar-Apr 1998;16(2):118-24. [Medline].

  4. Savvidou S, Goulis J, Gantzarou A, Ilonidis G. Pneumobilia, chronic diarrhea, vitamin K malabsorption: a pathognomonic triad for cholecystocolonic fistulas. World J Gastroenterol. Aug 28 2009;15(32):4077-82. [Medline].

  5. Schiller LR. Diarrhea and malabsorption in the elderly. Gastroenterol Clin North Am. Sep 2009;38(3):481-502. [Medline].

  6. Juckett G, Trivedi R. Evaluation of chronic diarrhea. Am Fam Physician. Nov 15 2011;84(10):1119-26. [Medline].

  7. Bhat DS, Thuse NV, Lubree HG, et al. Increases in plasma holotranscobalamin can be used to assess vitamin B-12 absorption in individuals with low plasma vitamin B-12. J Nutr. Nov 2009;139(11):2119-23. [Medline].

  8. Liu K, Kaffes AJ. Iron deficiency anaemia: a review of diagnosis, investigation and management. Eur J Gastroenterol Hepatol. Dec 7 2011;[Medline].

  9. Ghoshal UC, Kumar S, Chourasia D, Misra A. Lactose hydrogen breath test versus lactose tolerance test in the tropics: does positive lactose tolerance test reflect more severe lactose malabsorption?. Trop Gastroenterol. Apr-Jun 2009;30(2):86-90. [Medline].

  10. Casterton PL, Verbeke KA, Brouns F, Dammann KW. Evaluation of sucromalt digestion in healthy children using breath hydrogen as a biomarker of carbohydrate malabsorption. Food Funct. Dec 14 2011;[Medline].

  11. Hope HB, Tveito K, Aase S, et al. Small intestinal malabsorption in chronic alcoholism determined by (13)C-D-xylose breath test and microscopic examination of the duodenal mucosa. Scand J Gastroenterol. 2010;45(1):39-45. [Medline].

  12. Bai JC. Malabsorption syndromes. Digestion. Aug 1998;59(5):530-46. [Medline].

  13. Born P, Sekatcheva M, Rosch T, et al. Carbohydrate malabsorption in clinical routine: a prospective observational study. Hepatogastroenterology. Sep-Oct 2006;53(71):673-7.

  14. Camilleri M. Gastrointestinal problems in diabetes. Endocrinol Metab Clin North Am. Jun 1996;25(2):361-78. [Medline].

  15. Ciclitira PJ, King AL, Fraser JS. AGA technical review on celiac sprue. Gastroenterology. May 2001;120(6):1526-40. [Medline].

  16. Donner CS. Pathophysiology and therapy of chronic radiation-induced injury to the colon. Dig Dis. Jul-Aug 1998;16(4):253-61. [Medline].

  17. Doty JE, Fink AS, Meyer JH. Alterations in digestive function caused by pancreatic disease. Surg Clin North Am. Jun 1989;69(3):447-65. [Medline].

  18. Farthing MJ. Giardiasis. Gastroenterol Clin North Am. Sep 1996;25(3):493-515. [Medline].

  19. Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum. Gastroenterology. Feb 2001;120(3):636-51. [Medline].

  20. Gudmand-Hoyer E, Skovbjerg H. Disaccharide digestion and maldigestion. Scand J Gastroenterol Suppl. 1996;216:111-21. [Medline].

  21. Hansson GC. Cystic fibrosis and chloride-secreting diarrhoea. Nature. Jun 23 1988;333(6175):711. [Medline].

  22. Hirschowitz BI. Zollinger-Ellison syndrome: pathogenesis, diagnosis, and management. Am J Gastroenterol. Apr 1997;92(4 Suppl):44S-48S; discussion 49S-50S. [Medline].

  23. Husebye E. Gastrointestinal motility disorders and bacterial overgrowth. J Intern Med. Apr 1995;237(4):419-27. [Medline].

  24. Janecki AJ. Why should a clinician care about the molecular biology of transport?. Curr Gastroenterol Rep. 2000;2(5):378-86. [Medline].

  25. Karras PJ, Pfeifer MA. Diabetic gastrointestinal autonomic neuropathy. Curr Ther Endocrinol Metab. 1997;6:462-5. [Medline].

  26. Kastin DA, Buchman AL. Malnutrition and gastrointestinal disease. Curr Opin Gastroenterol. Mar 2002;18(2):221-8. [Medline].

  27. Kelly KJ. Eosinophilic gastroenteritis. J Pediatr Gastroenterol Nutr. 2000;30 Suppl:S28-35. [Medline].

  28. Lai Ping So A, Mayer L. Gastrointestinal manifestations of primary immunodeficiency disorders. Semin Gastrointest Dis. Jan 1997;8(1):22-32. [Medline].

  29. Leffler D, Saha S, Farrell RJ. Celiac disease. Am J Manag Care. Dec 2003;9(12):825-31; quiz 832-3. [Medline].

  30. Levy E. The genetic basis of primary disorders of intestinal fat transport. Clin Invest Med. Oct 1996;19(5):317-24. [Medline].

  31. Lindley KJ, Macdonald S. Malabsorption in children. Practitioner. Mar 2001;245(1620):162-4, 166, 169-70 passim. [Medline].

  32. Lock G, Holstege A, Lang B, et al. Gastrointestinal manifestations of progressive systemic sclerosis. Am J Gastroenterol. May 1997;92(5):763-71. [Medline].

  33. Lovat LB, Pepys MB, Hawkins PN. Amyloid and the gut. Dig Dis. May-Jun 1997;15(3):155-71. [Medline].

  34. Meysman M, Debeuckelaer S, Reynaert H, et al. Systemic amyloidosis-induced diarrhea in sex-linked agammaglobulinemia. Am J Gastroenterol. Aug 1993;88(8):1275-7. [Medline].

  35. Parnell ND, Ciclitira PJ. Review article: coeliac disease and its management. Aliment Pharmacol Ther. Jan 1999;13(1):1-13. [Medline].

  36. Pelletier VA, Galeano N, Brochu P, et al. Secretory diarrhea with protein-losing enteropathy, enterocolitis cystica superficialis, intestinal lymphangiectasia, and congenital hepatic fibrosis: a new syndrome. J Pediatr. Jan 1986;108(1):61-5. [Medline].

  37. Perri F, Clemente R, Festa V, et al. Pancreatic exocrine function tests. Scand J Gastroenterol. Oct 1998;33(10):1118-20. [Medline].

  38. Ramaiah C, Boynton RF. Whipple's disease. Gastroenterol Clin North Am. Sep 1998;27(3):683-95, vii. [Medline].

  39. Rose S, Young MA, Reynolds JC. Gastrointestinal manifestations of scleroderma. Gastroenterol Clin North Am. Sep 1998;27(3):563-94. [Medline].

  40. Saltzman JR, Russell RM. Nutritional consequences of intestinal bacterial overgrowth. Compr Ther. 1994;20(9):523-30. [Medline].

  41. Slater GH, Ren CJ, Siegel N, et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg. Jan 2004;8(1):48-55; discussion 54-5. [Medline].

  42. Vardy PA, Lebenthal E, Shwachman H. Intestinal lymphagiectasia: a reappraisal. Pediatrics. Jun 1975;55(6):842-51. [Medline].

  43. Vesy CJ, Peterson WL. Review article: the management of giardiasis. Aliment Pharmacol Ther. Jul 1999;13(7):843-50. [Medline].

  44. Virally-Monod M, Tielmans D, Kevorkian JP, et al. Chronic diarrhoea and diabetes mellitus: prevalence of small intestinal bacterial overgrowth. Diabetes Metab. Dec 1998;24(6):530-6. [Medline].

  45. Washington K, Stenzel TT, Buckley RH, et al. Gastrointestinal pathology in patients with common variable immunodeficiency and X-linked agammaglobulinemia. Am J Surg Pathol. Oct 1996;20(10):1240-52. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.