eMedicine Specialties > Pediatrics: General Medicine > Gastroenterology

Malabsorption Syndromes: Follow-up

Author: Stefano Guandalini, MD, Director, University of Chicago Celiac Disease Program, Section Chief of Gastroenterology, Hepatology and Nutrition; Professor, Department of Pediatrics, University of Chicago Comer Children's Hospital
Coauthor(s): Richard E Frye, MD, PhD, Assistant Professor, Departments of Pediatrics and Neurology, University of Texas Health Science Center at Houston; M Akram Tamer, MD, Program Director, Professor, Department of Pediatrics, University of Miami
Contributor Information and Disclosures

Updated: Oct 23, 2009

Follow-up

Further Inpatient Care

  • If a patient with a malabsorption syndrome shows any symptoms of dehydration or malnutrition, admit the patient to a medical care facility and immediately initiate treatment with parenteral fluid and nutrition supplements.
  • Treatment for severe acquired carbohydrate malabsorption requires admission to a medical care facility for enteral nutrition with a low-carbohydrate formula and administration of parenteral dextrose.

Further Outpatient Care

  • Strict follow-up monitoring with the primary care pediatrician is necessary to reevaluate diet therapy efficacy and compliance.

Deterrence/Prevention

  • The availability of sensitive and specific serological testing for celiac disease, namely the antitissue transglutaminase and the newer antideamidated gliadin peptides antibodies, allows the screening of first-degree relatives of patients, in whom the prevalence of celiac disease is higher.14
  • Asymptomatic subjects with positive results and celiac disease that is eventually confirmed by biopsy findings can then initiate a gluten-free diet, thus preventing all malabsorptive symptoms.

Prognosis

  • Mucosal atrophy caused by infectious gastroenteritis, food-sensitivity enteropathies, or malnutrition can result in an 80% reduction of intestinal surface area. Once the causative agent is removed, the repair of the small bowel is usually rapid (4-6 days). In some patients, repair may be slow, and after 2 months, the villi surface area is 63% normal and the microvillous surface area is only 38% normal.
  • Some malabsorption syndromes are transient, whereas others simply require a change in diet. Most disorders that cause secondary malabsorption are progressive and, because of systemic complications, result in a limited lifespan in patients. For example, patients with abetalipoproteinemia can die in early adulthood because of cardiac abnormalities, whereas patients with severe autoimmune enteropathies or microvillus inclusion disease have a very poor prognosis without intestinal transplantation.
  • Outcome in patients with short gut syndrome varies. The long-term prognosis depends primarily on the amount of time parenteral nutrition is required. The complications of parenteral nutrition and the lack of trophic stimulation of intestinal mucosal growth impede recovery. Delayed intestinal autonomy depends on the characteristics of the residual intestine length, presence of the ileocecal valve and colon, and motor function. Bacterial overgrowth compromises intestinal adaptation and increases the risk of liver disorders.
 


More on Malabsorption Syndromes

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Multimedia: Malabsorption Syndromes
References
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References

  1. Fasano A, Berti I, Gerarduzzi T, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. Feb 10 2003;163(3):286-92. [Medline].

  2. Rubio-Tapia A, Kyle RA, Kaplan EL, et al. Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology. Jul 2009;137(1):88-93. [Medline].

  3. Abenavoli L, Proietti I, Vonghia L, et al. Intestinal malabsorption and skin diseases. Dig Dis. 2008;26(2):167-74. [Medline].

  4. Scarpellini E, Giorgio V, Gabrielli M, et al. Prevalence of small intestinal bacterial overgrowth in children with irritable bowel syndrome: a case-control study. J Pediatr. Sep 2009;155(3):416-20. [Medline].

  5. Bruno MJ, Haverkort EB, Tytgat GN, van Leeuwen DJ. Maldigestion associated with exocrine pancreatic insufficiency: implications of gastrointestinal physiology and properties of enzyme preparations for a cause-related and patient-tailored treatment. Am J Gastroenterol. Sep 1995;90(9):1383-93. [Medline].

  6. Ford GA, Preece JD, Davies IH, Wilkinson SP. Use of the SeHCAT test in the investigation of diarrhoea. Postgrad Med J. Apr 1992;68(798):272-6. [Medline].

  7. Wedlake L, A'Hern R, Russell D, Thomas K, Walters JR, Andreyev HJ. Systematic review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. Oct 2009;30(7):707-17. [Medline].

  8. Mokrowiecka A, Daniel P, Slomka M, Majak P, Malecka-Panas E. Clinical utility of serological markers in inflammatory bowel disease. Hepatogastroenterology. Jan-Feb 2009;56(89):162-6. [Medline].

  9. Ritchie BK, Brewster DR, Davidson GP, Tran CD, McNeil Y, Hawkes JS. 13C-sucrose breath test: novel use of a noninvasive biomarker of environmental gut health. Pediatrics. Aug 2009;124(2):620-6. [Medline].

  10. Rizzello CG, De Angelis M, Di Cagno R, et al. Highly efficient gluten degradation by lactobacilli and fungal proteases during food processing: new perspectives for celiac disease. Appl Environ Microbiol. Jul 2007;73(14):4499-507. [Medline].

  11. [Guideline] Hill ID, Dirks MH, Liptak GS, et al. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. Jan 2005;40(1):1-19. [Medline].

  12. Quigley EM, Quera R. Small intestinal bacterial overgrowth: roles of antibiotics, prebiotics, and probiotics. Gastroenterology. 2006;130:S78-90. [Medline].

  13. Lauritano EC, Gabrielli M, Scarpellini E, et al. Antibiotic therapy in small intestinal bacterial overgrowth: rifaximin versus metronidazole. Eur Rev Med Pharmacol Sci. Mar-Apr 2009;13(2):111-6. [Medline].

  14. Volta U, Granito A, Fiorini E, et al. Usefulness of antibodies to deamidated gliadin peptides in celiac disease diagnosis and follow-up. Dig Dis Sci. Jun 2008;53(6):1582-8. [Medline].

  15. Adachi JA, DuPont HL. Rifaximin: a novel nonabsorbed rifamycin for gastrointestinal disorders. Clin Infect Dis. Feb 15 2006;42(4):541-7. [Medline].

  16. Cavataio F, Guandalini S. Cow's milk allergy. In: Guandalini S, ed. Essential Pediatric Gastroenterology. McGraw-Hill; 2005:175-92.

  17. Cole CR, Ziegler TR. Small bowel bacterial overgrowth: a negative factor in gut adaptation in pediatric SBS. Curr Gastroenterol Rep. Dec 2007;9(6):456-62. [Medline].

  18. Crenn P, Messing B, Cynober L. Citrulline as a biomarker of intestinal failure due to enterocyte mass reduction. Clin Nutr. Jun 2008;27(3):328-39. [Medline].

  19. Fonnesu C, Giovinale M, Verrecchia E, et al. Gastrointestinal amyloidosis: a case of chronic diarrhoea. Eur Rev Med Pharmacol Sci. Mar 2009;13 Suppl 1:45-50. [Medline].

  20. Goulet O, Ruemmele F. Causes and management of intestinal failure in children. Gastroenterology. 2006;130 (2 Suppl 1):S16-28. [Medline].

  21. Green PH, Jabri B. Celiac disease. Annu Rev Med. 2006;57:207-21. [Medline].

  22. Guandalini S, Dincer AP. Nutritional management in diarrhoeal disease. Baillieres Clin Gastroenterol. 1998;12:697-717. [Medline].

  23. Gupte GL, Beath SV, Kelly DA, et al. Current issues in the management of intestinal failure. Arch Dis Child. 2006;91:259-64. [Medline].

  24. Kneepkens CM, Hoekstra JH. Chronic nonspecific diarrhea of childhood: pathophysiology and management. Pediatr Clin North Am. Apr 1996;43(2):375-90. [Medline].

  25. Longo N, Elsas LJ. Human glucose transporters. Adv Pediatr. 1998;45:293-313. [Medline].

  26. Love MW, Dawson PA. New insights into bile acid transport. Curr Opin Lipidol. Jun 1998;9(3):225-9. [Medline].

  27. Maldonado J, Gil A, Narbona E, Molina JA. Special formulas in infant nutrition: a review. Early Hum Dev. Dec 1998;53 Suppl:S23-32. [Medline].

  28. Montalto M, Curigliano V, Santoro L, et al. Management and treatment of lactose malabsorption. World J Gastroenterol. 2006;12:187-91. [Medline].

  29. Montalto M, Santoro L, D'Onofrio F, Curigliano V, Visca D, Gallo A, et al. Classification of malabsorption syndromes. Dig Dis. 2008;26(2):104-11. [Medline].

  30. Nakamura T, Takeuchi T, Tando Y. Pancreatic dysfunction and treatment options. Pancreas. Apr 1998;16(3):329-36. [Medline].

  31. Robayo-Torres CC, Quezada-Calvillo R, Nichols BL. Disaccharide digestion: clinical and molecular aspects. Clin Gastroenterol Hepatol. 2006;4:276-87. [Medline].

  32. Vignes S, Bellanger J. Primary intestinal lymphangiectasia (Waldmann's disease). Orphanet J Rare Dis. Feb 22 2008;3:5. [Medline].

  33. Weiss B, Skourikhin Y, Modan-Moses D, Broide E, Fradkin A, Bujanover Y. Is adult height of patients with celiac disease influenced by delayed diagnosis?. Am J Gastroenterol. Jul 2008;103(7):1770-4. [Medline].

  34. Zanchi C, Di Leo G, Ronfani L, Martelossi S, Not T, Ventura A. Bone metabolism in celiac disease. J Pediatr. Aug 2008;153(2):262-5. [Medline].

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Further Reading

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Keywords

malabsorption syndromes, carbohydrate intolerance, chronic diarrhea of infancy, abdominal distention, failure to thrive, intestinal hydrolysis, creatorrhea, monosaccharide intolerance, steatorrhea, protein malabsorption, cystic fibrosis, Shwachman-Diamond syndrome, congenital lactase deficiency, amylase deficiency, adult-type hypolactasia, lactose intolerance, enteritis, mucosal atrophy, enterokinase deficiency, milk protein allergy enteropathy, steatorrhea, soy milk protein allergy, malnutrition, Giardia infections, abdominal pain, inflammatory bowel disease, borborygmi, protein sensitivity, pancreatic insufficiency, pancreatitis, pancreatic cancer, pancreatic resection, Johnson-Blizzard syndrome, Pearson syndrome, abetalipoproteinemia, protein-losing enteropathy, congenital enterokinase deficiency, Crohn disease

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Contributor Information and Disclosures

Author

Stefano Guandalini, MD, Director, University of Chicago Celiac Disease Program, Section Chief of Gastroenterology, Hepatology and Nutrition; Professor, Department of Pediatrics, University of Chicago Comer Children's Hospital
Stefano Guandalini, MD is a member of the following medical societies: American Gastroenterological Association, European Society for Paediatric Gastroenterology, Hepatology & Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Coauthor(s)

Richard E Frye, MD, PhD, Assistant Professor, Departments of Pediatrics and Neurology, University of Texas Health Science Center at Houston
Richard E Frye, MD, PhD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society, and International Neuropsychological Society
Disclosure: Nothing to disclose.

M Akram Tamer, MD, Program Director, Professor, Department of Pediatrics, University of Miami
M Akram Tamer, MD is a member of the following medical societies: American Medical Association and Florida Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Alan D Schmetzer, MD, Professor and Vice-Chair for Education, Director of Residency Training, Department of Psychiatry, Indiana University School of Medicine
Alan D Schmetzer, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, American Society of Transplant Surgeons, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

B UK Li, MD, Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Director, Pediatric Fellowships and Gastroenterology Fellowship, Medical Director, Functional Gastrointestinal Disorders and Cyclic Vomiting Program, Medical College of Wisconsin; Attending Gastroenterologist, Children's Hospital of Wisconsin
B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

CME Editor

Steven M Schwarz, MD, FAAP, FACN, AGAF, Professor of Pediatrics, Children's Hospital at Downstate, SUNY-Downstate Medical Center
Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research
Disclosure: TAP Pharmaceuticals Honoraria Speaking and teaching; Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor

Chief Editor

Carmen Cuffari, MD, Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine
Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

 
 
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