Gastrointestinal Malabsorption
Gastrointestinal malabsorption means a failure to fully absorb digested foods from the gut (bowel) into your body. There are many different causes. Prolonged intestinal malabsorption may cause problems because of a lack of carbohydrates, proteins, fats, minerals and vitamins that are essential to keep you healthy.
The treatment will depend on the cause of malabsorption but will also include supplements and other ways to make up for the reduced amount of carbohydrate, protein, fat, minerals and vitamins getting into your body.
What are the symptoms of gastrointestinal malabsorption?
There may be no symptoms if the malabsorption is mild and has not continued for very long. More severe or persistent malabsorption may lead to:
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- Tiredness (fatigue): because of a lack of energy and essential vitamins absorbed from food.
- Weight loss: if you can't absorb enough energy (calories) from your food then this will cause you to lose weight (and may cause poor growth in children).
- Persistent (chronic) diarrhoea: this is a common symptom of persistent malabsorption.
- Pale, bulky and smelly stools (steatorrhoea): there is excessive fat in the stools and they become pale, bulky and very smelly. Stools float and are difficult to flush away. They often leave a greasy rim around the pan.
Intestinal malabsorption may also cause:
- Iron deficiency and iron-deficiency anaemia.
- Folate deficiency.
- Vitamin B12 deficiency.
- Abnormal bleeding, caused by low vitamin K.
- Vitamin D deficiency including rickets and osteomalacia.
- Oedema, which occurs because of insufficient protein and calories absorbed into the body.
There may also be other symptoms due to the particular underlying condition that is causing the malabsorption.
What are the causes of gastrointestinal malabsorption?
The most common causes in the UK are coeliac disease, Crohn's disease and chronic pancreatitis. However, the malabsorption of simple carbohydrates affects about 1 in 4 people in Europe. Some diseases associated with malabsorption are found more often in some families - for example, coeliac disease, Crohn's disease, cystic fibrosis and lactose intolerance.
The causes of gastrointestinal malabsorption include:
Problems with absorbing food from the gut (bowel) into your body
- Coeliac disease.
- Lactose intolerance.
- Cow's milk protein allergy.
- Soya milk intolerance.
- Fructose intolerance.
- Infection - for example, intestinal tuberculosis, traveller's diarrhoea.
- Immune deficiency - for example, HIV infection.
- Pancreatic insufficiency - for example, cystic fibrosis, chronic pancreatitis, pancreatic cancer.
- Bile acid malabsorption.
Structural causes
Malabsorption may be cause by loss of part of the bowel that is essential to absorb the broken down (digested) food into the body - for example:
- Removal of the stomach or part of the bowel after a stomach or bowel operation.
- Crohn's disease.
Causes outside the bowel
Examples include:
- An overactive thyroid gland (hyperthyroidism).
- Eating disorders: anorexia nervosa, bulimia nervosa.
What tests are needed?
Initial tests will include blood tests and stool tests. Further tests may include an abdominal ultrasound scan, barium studies and a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan. Any further tests will depend on the likely underlying cause of the intestinal malabsorption.
What are the treatments for gastrointestinal malabsorption?
The treatment will mainly depend on the underlying cause of the malabsorption. However, treatment will also be needed to increase the amount of essential nutrients in the body, including carbohydrates, proteins, fats, minerals and vitamins (nutritional support).
Further reading and references
Murray JA, Rubio-Tapia A; Diarrhoea due to small bowel diseases. Best Pract Res Clin Gastroenterol. 2012 Oct26(5):581-600. doi: 10.1016/j.bpg.2012.11.013.
Hackert T, Schutte K, Malfertheiner P; The Pancreas: Causes for Malabsorption. Viszeralmedizin. 2014 Jun30(3):190-7. doi: 10.1159/000363778.
Raithel M, Weidenhiller M, Hagel AF, et al; The malabsorption of commonly occurring mono and disaccharides: levels of investigation and differential diagnoses. Dtsch Arztebl Int. 2013 Nov 15110(46):775-82. doi: 10.3238/arztebl.2013.0775.
Ramakrishna BS, Venkataraman S, Mukhopadhya A; Tropical malabsorption. Postgrad Med J. 2006 Dec82(974):779-87.
Keller J, Layer P; The Pathophysiology of Malabsorption. Viszeralmedizin. 2014 Jun30(3):150-4. doi: 10.1159/000364794.
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