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NEWSLETTER 7 : INTESTINAL MALABSORPTION                                                      (Updated April 2008)

Be Informed and Evaluate Your Risk of Intestinal Malabsorption

Definition
Symptoms
Consequences
Laboratory Tests
Treatment
Lexicon

DEFINITION :

Intestine The term malabsorption covers more than 25 diseases and syndromes (L).

Disorders of the digestion are responsible of some of those conditions. In pancreatic insufficiency the pancreas (L) secretes few or none of its enzymes into the gut. As a consequence, food is not broken down in particles that can be absorbed. In biliary tract disease, the absence or the reduction of bile (L) dramatically disturbs the absorption of fat. Some rare diseases involve lesions blocking the lymphatic pathway (L).


Most frequently malabsorption is caused by lesions of the intestinal mucosa cells (L) and by the lesions of the cells in the layer next to the mucosa, the cells from the lamina propria (L).

A normal stool mass averages 100-200 grams per day in an adult. A normal stool is well formed, with various shades of brown. A normal stool is flexible and easy to pass, about 1 or 1 1/2 inch in diameter and about 3-8 inches in length. A normal stool also makes a clean exit from the anus. More information on normal stool (ex)

In malabsorption, the higher volume of food remaining in the intestine without being absorbed causes abdominal cramps and is responsible for a larger stool mass.

If the intestinal motility is maintained in people with malabsorption the larger stool mass will be divided into several bowel movements over the day and the greater volume of the stool mass is less perceived or may go unnoticed.
Should some constipation be present, the larger mass of stool may be issued in one bowel movement or in one bowel movement every two day.

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SYMPTOMS :

Some abdominal pain is common and constant in malabsorption. People with malabsorption experience a little cramping before a bowel movement. Bloating and flatus will occur particularly in those patients with intestinal mucosa cell lesions. The bacterial flora sours the non absorbed carbohydrates (L) of food, producing gases, the origin of bloating and flatus. If the malabsorption is not severe and the appetite sufficient, a higher food intake may compensate in part for the lower absorption.

Malabsorption in one of the few conditions in which weight loss can occur despite an abundant food intake. Some people with malabsorption present diarrhea. Diarrhea in toddlers and children should focus attention on the condition of their intestine. As far as intestinal malabsorption is concerned, the main problem is the diagnosis. Malabsorption is dramatically under diagnosed (Gasbarrini G. 1994)

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CONSEQUENCES :

Larger than normal stool mass, abdominal pain, bloating and flatus are the first symptoms of malabsorption. Should malabsorption endure, other symptoms will develop, related to the gravity and the duration of the various deficiencies caused by malabsorption of food and of vitamins and minerals.

Examples :

Here are a few examples of the health conditions triggered by the various deficiencies that may result from malabsorption;

- Iron deficiency causes anemia in up to 20% of patients with malabsorption. Iron deficiency results in anemia by reducing the supply of hemoglobin, the oxygen transporting pigment of our red blood cells. Zinc is essential for many enzymes. The moost noticeable effect of a zinc deficiency is that you loose your taste.

- Since malabsorption reduces the supply of folates (L), the resulting folate deficiency will cause abnormal growth of the red blood cells. During their maturation some of the cells will become microcytic (L) , some will become macrocytic (L) . Vitamin B12 will also be less absorbed. Vitamin B12 deficiency occurs late, where it may take up to 5 years to deplete the body store of vitamin B12. It should be noted that vitamin B12 is the only vitamin where body storage can last that long. Vitamin B group deficiency alters the function of the cells in the nervous system, causing peripheral neuropathy (L) . Furthermore deficiency of the vitamin B group and particularly a deficiency of folates associated with vitamin B12 and vitamin B6 deficiency accelerates the inflammation of the arterial wall (arteriosclerosis) responsible for heart attack and stroke.

- Vitamin A deficiency induces xerophtalmia (L) and impairs the biochemistry in cells of the retina (L) causing night blindness.

In malabsorption, the lesions from the mucosa cells of the intestine may be associated with protein leakage.
- As a result of protein deprivation, Edema from the lower extremities may follow.

Malabsorption of calcium exaggerates the consequences of calcium deficiency

- Calcium malabsorption in osteoporosis, bone fragility and spontaneous bone fracture.

Calcium is absorbed throughout the length of the small intestine, but like other nutrients, more avidly in the proximal section, the most damaged part of the intestine in malabsorption. Other factors than calcium may be involved in bone lesions caused by malabsorption, such as a vitamin D deficiency and a shortage of boron possibly caused by the same malabsorption.

Osteomalacia (l) develops in patients with years of relatively mild malabsorption.

Malabsorption of fats has multiple consequences

- In fat malabsorption, fatty acids remain in the intestine. Calcium, as a divalent cation, combines with fatty acids to form insoluble soaps (and soapy stool)

- In fat malabsorption a deficiency of fat soluble vitamins (A,E,D) is frequent.

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LABORATORY TESTS :

A simple test for intestinal malabsorption is the Sudan Stain Test (L):

TREATMENT :

If you believe you have intestinal malabsorption see your health professional

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LEXICON :

Bile
Also named gall. Bile is the secretion of the liver. It contains water, inorganic salts, bile salts, and bile pigments. About 500-800 millilters are secreted daily. [ back to top ]

Carbohydrates
Compounds such as sugar and starch. Carbohydrates are of central importance in cell metabolism. [ back to top ]

Folates
A sub group of the vitamin B group. Folates are essential for the function of the nervous system and for the blood formation. [ back to top ]

Lamina Propria
The layer situated under the intestinal mucosa. The Lamina Propria contains cells that participate in the absorption of nutrients. [ back to top ]

Lymphatic
Small vessels pervading the body and containing lymph. The lymph vessels participate in the transport of some nutrients after absorption. [ back to top ]

Macrocytic
With a larger than normal diameter. [ back to top ]

Microcytic
With a shorter than normal diameter. [ back to top ]

Intestinal Mucosa Cells
Layer of cells lining the surface of the intestine and responsible of aliment absorption. [ back to top ]

Osteomalacia
Condition of softening of the bones in an adult person. [ back to top ]

Pancreas
A gland situated in the abdomen in relation to the intestine. It secretes a mixture of digestive enzymes into the intestine when stimulated during digestion. The pancreas also contain cells producing insulin. [ back to top ]

Peripheral Neuropathy
Inflammation of the peripheral nerves. [ back to top ]

Retina
Layer lining the interior of the eye which contains the light-sensitive receptor cells, the rods and the cones. [ back to top ]

Sudan Stain Test

Steps :
1 - Dissolve in water or saline of a small stool sample
2 - Add several drops of glacial acetic acid (hydrolyzes the insoluble salts of fatty acids)
3 - Add drops of alcoholic Sudan stain
4 - Spread on a slide, cover, heat to boiling twice
5 - Examine under microscope. Stool of normal individuals display only a few small droplets.

Accuracy : The Sudan stain test detects 80 to 90% of fat malabsorption.

Errors : Errors may occurs in the presence of non absorbable mineral oils, like castor oil used to prepare patients for bowel X-ray procedures, that gives false positive tests. [ back to top ]

Syndrome
A collection of symptoms and/or signs that comprise a recognizable pattern of disease. [ back to top]

Xerophtalmia
Ulceration (superficial wound) of the cornea (the transparent eye membrane) occurring in vitamin A deficiency. [ back to top]

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