Medical Care

Two basic principles underlie the management of patients with malabsorption, (1) the correction of nutritional deficiencies, and (2) when possible, the treatment of causative diseases.

Nutritional support

Caloric and protein replacement is essential. It is crucial to supplement the patient with various minerals, such as calcium, magnesium, iron, and vitamins, which may be deficient in malabsorption.

Medium-chain triglycerides can be used as fat substitutes, because they do not require micelle formation for absorption and their route of transport is portal rather than lymphatic.

In severe intestinal disease, such as extensive regional enteritis and following a massive resection, parenteral nutrition may become necessary.

Treatment of causative diseases

A gluten-free diet helps treat celiac disease. Similarly, a lactose-free diet helps correct lactose intolerance; supplementing the first bite of milk-containing food products with a product such as Lactaid also helps.

The use of protease and lipase supplements are the therapy for pancreatic insufficiency. Antibiotics are used to treat small intestinal bacterial overgrowth. Corticosteroids, anti-inflammatory agents, such as mesalamine, and other therapies are used to treat regional enteritis. Pancreatic enzymes supplementation is the treatment for pancreatic insufficiency.

Owens SR, Greenson JK. The pathology of malabsorption: current concepts. Histopathology. 2007 Jan. 50(1):64-82. [QxMD MEDLINE Link].
Raz M, Sharon Y, Yerushalmi B, Birk R. Frequency of LCT-13910C/T and LCT-22018G/A single nucleotide polymorphisms associated with adult-type hypolactasia/lactase persistence among Israelis of different ethnic groups. Gene. 2013 Apr 25. 519(1):67-70. [QxMD MEDLINE Link].
Santonocito C, Scapaticci M, Guarino D, et al. Lactose intolerance genetic testing: Is it useful as routine screening? Results on 1426 south-central Italy patients. Clin Chim Acta. 2015 Jan 15. 439:14-7. [QxMD MEDLINE Link].
Holt PR. Diarrhea and malabsorption in the elderly. Gastroenterol Clin North Am. 2001 Jun. 30(2):427-44. [QxMD MEDLINE Link].
Potter GD. Bile acid diarrhea. Dig Dis. 1998 Mar-Apr. 16(2):118-24. [QxMD MEDLINE Link].
Savvidou S, Goulis J, Gantzarou A, Ilonidis G. Pneumobilia, chronic diarrhea, vitamin K malabsorption: a pathognomonic triad for cholecystocolonic fistulas. World J Gastroenterol. 2009 Aug 28. 15(32):4077-82. [QxMD MEDLINE Link]. [Full Text].
Schiller LR. Diarrhea and malabsorption in the elderly. Gastroenterol Clin North Am. 2009 Sep. 38(3):481-502. [QxMD MEDLINE Link].
Juckett G, Trivedi R. Evaluation of chronic diarrhea. Am Fam Physician. 2011 Nov 15. 84(10):1119-26. [QxMD MEDLINE Link].
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. 2009 Nov. 139(11):2119-23. [QxMD MEDLINE Link].
Liu K, Kaffes AJ. Iron deficiency anaemia: a review of diagnosis, investigation and management. Eur J Gastroenterol Hepatol. 2012 Feb. 24(2):109-16. [QxMD MEDLINE Link].
Raman M, Fenton T, Crotty P, Ghosh S, Rioux K, Hundal R. A novel method to identify fat malabsorption: The Serum Retinyl Palmitate Test. Clin Chim Acta. 2015 Jan 1. 438:103-6. [QxMD MEDLINE Link].
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. 2009 Apr-Jun. 30(2):86-90. [QxMD MEDLINE Link].
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. 2012 Apr. 3(4):410-3. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Dutta AK, Sajith KG, Shah G, et al. Duodenal villous morphology assessed using magnification narrow band imaging correlates well with histology in patients with suspected malabsorption syndrome. Dig Endosc. 2014 Nov. 26(6):720-5. [QxMD MEDLINE Link].
Bai JC. Malabsorption syndromes. Digestion. 1998 Aug. 59(5):530-46. [QxMD MEDLINE Link].
Born P, Sekatcheva M, Rosch T, et al. Carbohydrate malabsorption in clinical routine: a prospective observational study. Hepatogastroenterology. 2006 Sep-Oct. 53(71):673-7.
Camilleri M. Gastrointestinal problems in diabetes. Endocrinol Metab Clin North Am. 1996 Jun. 25(2):361-78. [QxMD MEDLINE Link].
Ciclitira PJ, King AL, Fraser JS. AGA technical review on celiac sprue. Gastroenterology. 2001 May. 120(6):1526-40. [QxMD MEDLINE Link].
Donner CS. Pathophysiology and therapy of chronic radiation-induced injury to the colon. Dig Dis. 1998 Jul-Aug. 16(4):253-61. [QxMD MEDLINE Link].
Doty JE, Fink AS, Meyer JH. Alterations in digestive function caused by pancreatic disease. Surg Clin North Am. 1989 Jun. 69(3):447-65. [QxMD MEDLINE Link].
Farthing MJ. Giardiasis. Gastroenterol Clin North Am. 1996 Sep. 25(3):493-515. [QxMD MEDLINE Link].
Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum. Gastroenterology. 2001 Feb. 120(3):636-51. [QxMD MEDLINE Link].
Gudmand-Hoyer E, Skovbjerg H. Disaccharide digestion and maldigestion. Scand J Gastroenterol Suppl. 1996. 216:111-21. [QxMD MEDLINE Link].
Hansson GC. Cystic fibrosis and chloride-secreting diarrhoea. Nature. 1988 Jun 23. 333(6175):711. [QxMD MEDLINE Link].
Hirschowitz BI. Zollinger-Ellison syndrome: pathogenesis, diagnosis, and management. Am J Gastroenterol. 1997 Apr. 92(4 Suppl):44S-48S; discussion 49S-50S. [QxMD MEDLINE Link].
Husebye E. Gastrointestinal motility disorders and bacterial overgrowth. J Intern Med. 1995 Apr. 237(4):419-27. [QxMD MEDLINE Link].
Janecki AJ. Why should a clinician care about the molecular biology of transport?. Curr Gastroenterol Rep. 2000. 2(5):378-86. [QxMD MEDLINE Link].
Karras PJ, Pfeifer MA. Diabetic gastrointestinal autonomic neuropathy. Curr Ther Endocrinol Metab. 1997. 6:462-5. [QxMD MEDLINE Link].
Kastin DA, Buchman AL. Malnutrition and gastrointestinal disease. Curr Opin Gastroenterol. 2002 Mar. 18(2):221-8. [QxMD MEDLINE Link].
Kelly KJ. Eosinophilic gastroenteritis. J Pediatr Gastroenterol Nutr. 2000. 30 Suppl:S28-35. [QxMD MEDLINE Link].
Lai Ping So A, Mayer L. Gastrointestinal manifestations of primary immunodeficiency disorders. Semin Gastrointest Dis. 1997 Jan. 8(1):22-32. [QxMD MEDLINE Link].
Leffler D, Saha S, Farrell RJ. Celiac disease. Am J Manag Care. 2003 Dec. 9(12):825-31; quiz 832-3. [QxMD MEDLINE Link].
Levy E. The genetic basis of primary disorders of intestinal fat transport. Clin Invest Med. 1996 Oct. 19(5):317-24. [QxMD MEDLINE Link].
Lindley KJ, Macdonald S. Malabsorption in children. Practitioner. 2001 Mar. 245(1620):162-4, 166, 169-70 passim. [QxMD MEDLINE Link].
Lock G, Holstege A, Lang B, et al. Gastrointestinal manifestations of progressive systemic sclerosis. Am J Gastroenterol. 1997 May. 92(5):763-71. [QxMD MEDLINE Link].
Lovat LB, Pepys MB, Hawkins PN. Amyloid and the gut. Dig Dis. 1997 May-Jun. 15(3):155-71. [QxMD MEDLINE Link].
Meysman M, Debeuckelaer S, Reynaert H, et al. Systemic amyloidosis-induced diarrhea in sex-linked agammaglobulinemia. Am J Gastroenterol. 1993 Aug. 88(8):1275-7. [QxMD MEDLINE Link].
Parnell ND, Ciclitira PJ. Review article: coeliac disease and its management. Aliment Pharmacol Ther. 1999 Jan. 13(1):1-13. [QxMD MEDLINE Link].
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. 1986 Jan. 108(1):61-5. [QxMD MEDLINE Link].
Perri F, Clemente R, Festa V, et al. Pancreatic exocrine function tests. Scand J Gastroenterol. 1998 Oct. 33(10):1118-20. [QxMD MEDLINE Link].
Ramaiah C, Boynton RF. Whipple's disease. Gastroenterol Clin North Am. 1998 Sep. 27(3):683-95, vii. [QxMD MEDLINE Link].
Rose S, Young MA, Reynolds JC. Gastrointestinal manifestations of scleroderma. Gastroenterol Clin North Am. 1998 Sep. 27(3):563-94. [QxMD MEDLINE Link].
Saltzman JR, Russell RM. Nutritional consequences of intestinal bacterial overgrowth. Compr Ther. 1994. 20(9):523-30. [QxMD MEDLINE Link].
Slater GH, Ren CJ, Siegel N, et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg. 2004 Jan. 8(1):48-55; discussion 54-5. [QxMD MEDLINE Link].
Vardy PA, Lebenthal E, Shwachman H. Intestinal lymphagiectasia: a reappraisal. Pediatrics. 1975 Jun. 55(6):842-51. [QxMD MEDLINE Link].
Vesy CJ, Peterson WL. Review article: the management of giardiasis. Aliment Pharmacol Ther. 1999 Jul. 13(7):843-50. [QxMD MEDLINE Link].
Virally-Monod M, Tielmans D, Kevorkian JP, et al. Chronic diarrhoea and diabetes mellitus: prevalence of small intestinal bacterial overgrowth. Diabetes Metab. 1998 Dec. 24(6):530-6. [QxMD MEDLINE Link].
Washington K, Stenzel TT, Buckley RH, et al. Gastrointestinal pathology in patients with common variable immunodeficiency and X-linked agammaglobulinemia. Am J Surg Pathol. 1996 Oct. 20(10):1240-52. [QxMD MEDLINE Link].
Nikaki K, Gupte GL. Assessment of intestinal malabsorption. Best Pract Res Clin Gastroenterol. 2016 Apr. 30(2):225-35. [QxMD MEDLINE Link].
Quigley EMM. The spectrum of small intestinal bacterial overgrowth (SIBO). Curr Gastroenterol Rep. 2019 Jan 15. 21(1):3. [QxMD MEDLINE Link].
Fassio F, Facioni MS, Guagnini F. Lactose maldigestion, malabsorption, and intolerance: a comprehensive review with a focus on current management and future perspectives. Nutrients. 2018 Nov 1. 10(11):[QxMD MEDLINE Link]. [Full Text].

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Author

Muhammad Bader Hammami, MD Fellow in Inflammatory Bowel Disease, St Louis University School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Douglas M Heuman, MD, FACP, FACG, AGAF Chief of Hepatology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University 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, American Gastroenterological Association

Disclosure: Received grant/research funds from Novartis for other; Received grant/research funds from Bayer for other; Received grant/research funds from Otsuka for none; Received grant/research funds from Bristol Myers Squibb for other; Received none from Scynexis for none; Received grant/research funds from Salix for other; Received grant/research funds from MannKind for other.

Chief Editor

Praveen K Roy, MD, AGAF Clinical Assistant Professor of Medicine, University of New Mexico School of Medicine

Praveen K Roy, MD, AGAF is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

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, American Gastroenterological Association

Disclosure: Nothing to disclose.

Stephan U Goebel, MD Assistant Professor of Gastroenterology and Hepatology, Department of Medicine, Emory University School of Medicine

Stephan U Goebel, MD is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

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.

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.