Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pediatric Malabsorption Syndromes Medication

  • Author: Stefano Guandalini, MD; Chief Editor: Carmen Cuffari, MD  more...
 
Updated: Jul 17, 2015
 

Digestive enzymes

Class Summary

Pancreatic enzyme deficiency may occur because of steatorrhea secondary to malabsorption.

Pancrelipase (Ultrase, Pancrease, Creon)

 

Assists in digestion of protein, starch, and fat. Contains lipase, protease, and amylase.

Next

Bile acid–binding agents

Class Summary

These agents are used in combination with antibiotics for bile acid malabsorption syndromes. Bacteria overgrowth may cause diarrhea by deconjugation and dehydroxylation of bile acids. Primary bile acid malabsorption may also occur.

Cholestyramine (Questran)

 

Binds bile acids, thus reducing damage to the intestinal mucosa. Also reduces induction of colonic fluid secretion. Forms a nonabsorbable complex with bile acids in the intestine, which in turn inhibits enterohepatic reuptake of intestinal bile salts.

Previous
Next

Antibiotics

Class Summary

Metronidazole may be considered and provides anaerobic coverage. Although the use of rifaximin in children for the indication of small intestinal bacterial overgrowth is not US Food and Drug Administration (FDA)-approved, this antibiotic is virtually nonabsorbed (< 0.4%) and has been proven useful in the treatment of small intestinal bacterial overgrowth in adults.

Metronidazole (Flagyl)

 

DOC for documented small bowel bacterial overgrowth. Provides good anaerobic coverage.

Rifaximin (Xifaxan)

 

Nonabsorbed (< 0.4%), broad-spectrum antibiotic specific for enteric pathogens of the gastrointestinal tract (ie, Gram-positive, Gram-negative, aerobic and anaerobic). Rifampin structural analog. Binds to beta-subunit of bacterial DNA-dependent RNA polymerase, thereby inhibiting RNA synthesis. Indicated for E coli (enterotoxigenic and enteroaggregative strains) associated with travelers' diarrhea.

Previous
 
 
Contributor Information and Disclosures
Author

Stefano Guandalini, MD Founder and Medical Director, Celiac Disease Center, Chief, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Chicago Medical Center; Professor, Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Stefano Guandalini, MD is a member of the following medical societies: American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, European Society for Paediatric Gastroenterology, Hepatology & Nutrition, North American Society for the Study of Celiac Disease

Disclosure: Received consulting fee from AbbVie for consulting.

Coauthor(s)

Richard E Frye, MD, PhD Associate Professor, Department of Pediatrics, University of Arkansas for Medical Sciences

Richard E Frye, MD, PhD is a member of the following medical societies: American Academy of Neurology, Child Neurology Society, International Neuropsychological Society, American Academy of Pediatrics

Disclosure: Nothing to disclose.

M Akram Tamer, MD Professor, Program Director, Department of Pediatrics, University of Miami, Leonard M Miller School of Medicine

M Akram Tamer, MD is a member of the following medical societies: American Medical Association, Florida Medical Association

Disclosure: Nothing to disclose.

Catherine D Newland, MD Pediatric Gastroenterology Fellow, Comer Children’s Hospital, University of Chicago

Catherine D Newland, MD is a member of the following medical societies: American Academy of Pediatrics, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

B UK Li, MD Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin; Attending Gastroenterologist, Director, Cyclic Vomiting Program, Children’s Hospital of Wisconsin

B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

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, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching.

Additional Contributors

Eric S Maller, MD 

Eric S Maller, 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, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

References
  1. Siddiqui Z, Osayande AS. Selected disorders of malabsorption. Prim Care. 2011 Sep. 38(3):395-414; vii. [Medline].

  2. 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. 2003 Feb 10. 163(3):286-92. [Medline].

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

  4. Meyer R, Venter C, Fox AT, Shah N. Practical dietary management of protein energy malnutrition in young children with cow's milk protein allergy. Pediatr Allergy Immunol. 2012 Mar 22. [Medline].

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

  6. 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. 2009 Sep. 155(3):416-20. [Medline].

  7. 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. 1995 Sep. 90(9):1383-93. [Medline].

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

  9. 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. 2009 Oct. 30(7):707-17. [Medline].

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

  11. 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. 2009 Aug. 124(2):620-6. [Medline].

  12. Gabrielli M, D'angelo G, Di Rienzo T, Scarpellini E, Ojetti V. Diagnosis of small intestinal bacterial overgrowth in the clinical practice. Eur Rev Med Pharmacol Sci. 2013 Dec. 17 Suppl 2:30-5. [Medline].

  13. 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. 2007 Jul. 73(14):4499-507. [Medline].

  14. [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. 2005 Jan. 40(1):1-19. [Medline].

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

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

  17. Kumpf VJ. Pharmacologic Management of Diarrhea in Patients With Short Bowel Syndrome. JPEN J Parenter Enteral Nutr. 2014 Jan 24. [Medline].

  18. 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. 2008 Jun. 53(6):1582-8. [Medline].

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  33. 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].

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

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

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

  37. 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. 2008 Jul. 103(7):1770-4. [Medline].

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

 
Previous
Next
 
The small intestine is a major site of absorption.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.