Further Outpatient Care

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

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.

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.^[20]

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.

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Media Gallery

The small intestine is a major site of absorption.

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Author

Stefano Guandalini, MD, AGAF Founder and Director Emeritus, Celiac Disease Center, University of Chicago; Former Chief, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Chicago Medicine; Professor Emeritus, The University of Chicago Pritzker School of Medicine

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Imaware.health.

Coauthor(s)

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.

Richard E Frye, MD, PhD Professor of Child Health, University of Arizona College of Medicine at Phoenix; Chief of Neurodevelopmental Disorders, Director of Autism and Down Syndrome and Fragile X Programs, Division of Neurodevelopmental Disorders, Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital

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

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.

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. for: Abbott Nutritional, Abbvie, speakers' bureau.

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.