Malabsorption Syndrome: Causes, Symptoms, and Treatment

Malabsorption syndrome, also known as intestinal malabsorption and abbreviated as MAS, occurs due to incomplete digestion and absorption of nutrients like carbohydrates, proteins, fats, bacteria, and various other factors. It is common amongst both males and females across ages.

This syndrome varies from being mild and moderate to severe. It may be hereditary by nature or may be a personal medical condition.

Nutritional Absorption: 3 Stages 

It follows three stages.

Luminal phase: This stage includes the secretion of digestive enzymes and mechanical mixing.

Mucosal phase: This involves absorption of food consumed, which depends on whether the mucosal membrane is in a functioning condition.

Post-absorptive phase: This stage is initiated by interrupted blood supply and lymphatic system.

The efficacy of the digestive system is determined by the efficiency of each of these above stages. Dysfunction in digestion or absorption in any of these stages causes malabsorption. The type of malabsorption also depends on the nutrients that are not being digested or absorbed effectively. 

Types of Malabsorption

The types of malabsorption that may lead to a malabsorption syndrome are as below:

Fat malabsorption. This develops due to interruptions in efficient digestion and absorption of fats as the name suggests. It is one of the most common causes of intestinal malabsorption. 

Carbohydrate malabsorption. Lack of efficient digestion and absorption of carbohydrates like lactose, sucrose, and starch leads to MAS. In the normal process, carbohydrates are converted into monosaccharides. When this does not occur, malabsorption takes place.

Protein malabsorption. Interruption in the absorption and digestion of proteins by amino acids, pancreatic enzymes, and other elements is another factor that triggers intestinal malabsorption. 

Vitamin and mineral malabsorption. Incomplete digestion and absorption of vitamins, minerals, and other elements cause nutritional malabsorption. 

Hereditary malabsorption disorders. Allergies and food intolerance towards lactose, chloride, etc. is another prominent cause of malabsorption syndrome.

Immunodeficiency-related malabsorption. Malabsorption that cannot be categorized under any of the other factors generally get manifested through diarrhea and other symptoms. These symptoms include general malnutrition, loss of weight amongst others.

Bacterial malabsorption. In this case, incomplete digestion and absorption of food consumed is induced by certain bacteria like Cryptosporidium parvum (cryptosporidiosis), Giardia lamblia (giardiasis), Phylum microspora (microsporidiosis), and Tropheryma whipplei.

Medical Definition of Malabsorption Syndrome

Intestinal malabsorption is induced by pathological interference in the normal process of secretion of digestive enzymes in the gastrointestinal tract. This is characterised by incomplete digestion and absorption of food consumed. Apart from the intestines or gut, other organs involved in the dysfunction are the pancreas and gallbladder. It also occurs due to compromised blood supply and lack of beneficial bacterial flora.

Symptoms of Malabsorption Syndrome

Intestinal malabsorption manifests through symptoms like:

• Flatulence
• Bloating
• Slow growth and development amongst infants and children
• Chronic diarrhea
• Sticky stools or Steatorrhoea
• Slow healing of injury or wound, if any

However, the symptoms will not be the same for every patient. It varies between individuals.

Causes of Malabsorption Syndrome

There are a wide range of medical conditions that develop as a result of maldigestion and malabsorption. Each nutrient and other elements that lead to intestinal malabsorption may give rise to a different set of medical conditions. Let’s take a look at the possible malabsorption syndrome causes here:

Diseases and conditions that can cause fat malabsorption

• Crohn disease
• Zollinger-Ellison syndrome
• Celiac disease
• Ulcerative colitis
• Small intestinal bacterial overgrowth (SIBO)
• Small bowel resection 
• Pancreatic resection
• Chronic pancreatitis
• Cystic fibrosis
• Pancreatic cancer
• Lymphatic system disorders like whipple disease, intestinal lymphangiectasia
• Abetalipoproteinemia

Diseases and conditions that can cause carbohydrate malabsorption

• Hypolactasia or lactase deficiency
• Pancreatic amylase deficiency
• Autoimmune enteropathy
• Trehalase deficiency
• Sucrase deficiency
• Mural disease
• Inflammatory bowel disease (IBD)
• Autoimmune enteropathy
• Entero-enteric fistula
• Entero-colic fistula

Diseases and conditions that can cause protein malabsorption

• Cystic fibrosis
• Chronic pancreatitis
• Bowel resection

Diseases and conditions that can cause malabsorption of vitamins, minerals, and trace elements 

• Acrodermatitis enteropathica
• Intestinal resections

Genetic conditions that can cause chronic diarrhea

• Congenital chloride diarrhea (CCD)
• Congenital glucose-galactose malabsorption (GGM)
• Cow’s milk protein allergy (CMPA) 

Bacterial malabsorption

As discussed earlier in the article, maldigestion and malabsorption may also arise due to certain varieties of bacteria that impede the digestive process.

Risk Factors of Malabsorption Syndrome

The following factors may raise the risk of intestinal malabsorption:

• A genetic condition of malabsorption of cystic fibrosis
• In surgery of the intestine
• Certain drugs like laxatives and mineral oil
• Excessive consumption of alcohol

Diagnosis of Malabsorption Syndrome

The diagnostic procedure comprises physical examination based on the symptoms that you have explained to the doctor. This is followed by investigation of your personal and family history of medical conditions. Your doctor may then advise you to undergo some medical tests. These lab tests are for supporting his/her diagnosis and not a means of diagnosing the underlying cause of your symptoms.

The diagnostic tests that may be recommended based on your doctor’s suspected diagnosis of the underlying medical condition are as below:

• Blood tests: The blood tests that may be advised may include Complete Blood Cell Count (CBC) or Comprehensive Metabolic Panel. You may also be recommended blood tests that specialise in measuring levels of nutrients like zinc, magnesium, vitamins, phosphorus, iron panel, albumin, etc. 
• Fecal tests: Near-infrared reflectance analysis (NIRA), Acid steatocrit, and Sudan III stain are some of the tests that the doctor may advise.
• Computed Tomography (CT) for assessing pancreatitis
• Breath tests to detect bacterial overgrowth in small intestine
• Magnetic resonance cholangiopancreatography (MRCP)
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Cholangiopancreatography (MRCP)
• Jejunal aspirate culture
• Magnetic resonance (MR) elastography
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Colonoscopy with biopsies for ulcerative colitis
• Endoscopy with biopsies for diagnosing celiac disease, crohn disease, etc.
• Acid-fast stain to distinguish between certain species of bacteria

Treatment for Malabsorption Syndrome

• Strictly follow the diet recommended by the doctor. It should not include food products that are difficult or take more time to digest.
• Patients with food intolerance like lactose intolerance, which is the trigger for intestinal malabsorption, will be advised food products that they are intolerant to. 
• Surgical interventions like pancreatic enzyme replacement for exocrine pancreatic insufficiency or cholangiopancreatography (ERCP) for removing a stone in the pancreas.

Learn more about Other Digestive Issues here.