Malabsorption Syndrome: Causes, Symptoms, Diagnosis

Jan 16, 2020

Malabsorption is a condition in which the body is not absorbing the vitamins and minerals it should be receiving from food. This is a blanket term for an underlying disorder, which is what can make malabsorption syndrome tricky to diagnose. Malabsorption may refer to only one type of macronutrient not being absorbed properly (such as protein), or it may refer to all nutrients not being absorbed properly. It really depends on what the underlying problem is. Read on to learn more about malabsorption syndrome is, what its root causes may be, how it’s diagnosed, and what treatment options may be available.

What Is Malabsorption Syndrome?

Malabsorption syndrome occurs when something in the small intestine fails to do its job correctly. One of the functions of the small intestine is to absorb nutrients from the food we eat (or the fluids we drink) and make sure that these nutrients find their way into the bloodstream. However, in malabsorption syndrome, one or more macronutrients are not being absorbed properly. These can include macronutrients such as proteins, carbohydrates, and fats, as well as micronutrients such as vitamins and minerals. Malabsorption syndrome can also be a combination of the two. There is always a root cause underneath that is causing the small intestine to be inefficient or not to work properly.

Causes of Malabsorption Syndrome

There are many possible causes of malabsorption syndrome, and it may take doctors several tries before they can figure out what the underlying problem may be. They may look first at the small intestine to see if it is damaged. Damage from surgery, infection, trauma, or inflammation can cause the small intestine to function improperly.

Someone who has been on antibiotics too long may be prone to malabsorption. While it’s a must always to finish your antibiotics regimen, you should never take antibiotics unnecessarily or for a prolonged time. Most doctors are aware of antibiotics resistance as well as the long-term health complications from extended use. Other medications may contribute to malabsorption, such as tetracycline, colchicine, or cholestyramine.

Other GI-related diseases can cause malabsorption. These can include Crohn’s disease, pancreatitis, problems with the liver, gallbladder, or pancreas, celiac disease, and lactose intolerance. Cystic fibrosis can also cause malabsorption.

Biliary atresia is another consideration. This is a condition present from birth that prevents the flow of bile to flow from the liver properly.

There are also less common causes, but these should also be considered, especially in cases where malabsorption is severe.

Short bowel syndrome (SBS) is most often a birth defect. As the name suggests, a person is born with a small intestine that is too short. Because of this, it is less likely to absorb nutrients properly.

Other less likely causes include Whipple’s disease, which is related to a bacterial infection, and tropical sprue, a parasitic infection common to Southeast Asia, the Caribbean, and India.

Recognizing the Symptoms of Malabsorption Syndrome

Malabsorption syndrome symptoms differ slightly, depending upon what the root cause of the problem is. However, when you are not getting nutrients or vitamins and minerals properly, certain symptoms are going to be present, regardless of the underlying cause. A lot of these signs and symptoms of malabsorption syndrome can be somewhat universal across the board, although they do differ slightly. Some of the main symptoms that are noticeable are gastrointestinal in nature, such as stomach bloating or cramping, or even a distended stomach. Weakness and fatigue are also common complaints, especially if your body isn’t getting enough carbohydrates. Also, look for diarrhea, steatorrhea (pale or white stools), or stools that appear to have a greasy texture.

There are also long-term effects of not garnering enough nutrients in the diet. Many of these are often specific to the macro- or micronutrient that is not being absorbed, but in general, bone loss, unexplained weight loss, a sore tongue, muscle wasting, shortness of breath, and iron-deficiency anemia are all related to malabsorption syndrome.

Risk Factors for Malabsorption Syndrome

Because malabsorption syndrome is a blanket term for other disorders and conditions, it’s hard to determine the risk factors for any particular patient. However, speaking in very general terms, a family history of malabsorption problems or cystic fibrosis is perhaps the most significant risk factor. Drinking excessive amounts of alcohol must also be mentioned since this profoundly disrupts liver function and can prevent nutrients from them finding their way into your bloodstream. Other risk factors include travel abroad to the Caribbean, Southeast Asia, or India, overuse of laxatives or mineral oil, or intestinal surgery (and complications thereof).

Patients may also want to be aware of a family history of gastrointestinal conditions such as Crohn’s disease or ulcerative colitis (both collectively known together as inflammatory bowel disease (IBD).

Diagnosing Malabsorption Syndrome

One of the first steps for diagnosing malabsorption syndrome is to take a detailed patient history and have a thorough physical exam. For example, if a person is drinking excessive amounts of alcohol, this will likely be labeled alcohol use disorder and not malabsorption disorder, even though nutrients are not being properly absorbed. However, this problem is rectified with a lifestyle change.

After asking a series of questions and having a physical exam, your doctor may give you both stool and blood tests. If you have known nutrient deficiencies or you are suffering from chronic diarrhea (or both), this will help confirm the diagnosis of malabsorption syndrome. Alternatively, blood tests, such as a complete blood count (CBC), can find vitamin deficiencies.

Stool tests are the most reliable way to diagnose because they look for fat in the stool. If there is not enough fat present in the stool, doctors can surmise that there may be malabsorption present.

Doctors will typically order a CBC, the same type of blood test you get at your yearly physical. This looks at a battery of line items but will look specifically for deficiencies in vitamin B12, vitamin D, folate, carotene, calcium, protein, and phosphorous, among others.

A breath test is also a possibility. These are used to test for lactose intolerance. When lactose isn’t being properly metabolized, too many gases are released into the colon, including hydrogen. This results in excess hydrogen being detectable on a person’s breath. For the test, you will breathe into a special bag, and analysts will measure the amount of hydrogen that was noticeable in your breath. If the number is high, this points to a diagnosis of lactose intolerance, which may, in turn, point to a diagnosis of malabsorption syndrome.

Your doctor may also use imaging tests, such as CT scans, to look for conditions such as Crohn’s disease.

Treatment Options for Malabsorption Syndrome

Depending on the root cause, your physician will want to treat that condition as well (for example, Crohn’s has treatments very specific to it, as does cystic fibrosis), but to treat the malabsorption itself, your doctor will likely prescribe target vitamin and mineral supplements to replace the ones you haven’t been receiving. He or she may also suggest enzyme supplements, which can help the body absorb nutrients on its own when the small intestine can’t. Your doctor may also recommend lifestyle changes (mainly targeting the diet) to help your body absorb the nutrients it needs. If you need more information on malabsorption syndrome or would like to be evaluated by a physician, book an appointment at Carolina Digestive Health Associates today. We have 12 different locations throughout the state for your convenience, as well as an exceptional team that offers individualized care.