What is Malabsorption Syndrome: Causes, Types, Symptoms, Diagnosis, Treatment

The digestive system in humans is a complex system that works together with many organs. One such important organ is the small intestine. The small intestine has the function of absorbing nutrients from the food you consume into the bloodstream. While in most people, this process continues flawlessly without any disruption, individuals with malabsorption syndrome experience problems in the absorption of certain nutrients and fluids. There are many types of known disorders that cause malabsorption, including celiac disease and lactose intolerance. Sometimes people who have undergone stomach surgery or have a history of bowel surgery also experience malabsorption syndrome.

Here’s everything you need to know about malabsorption syndrome.

Malabsorption syndrome is an umbrella term used to refer to a variety of disorders in which the small intestine is not able to absorb certain nutrients and fluids. People with malabsorption syndrome are usually unable to absorb nutrients like carbohydrates, fats, proteins, vitamins, or minerals. Due to this disorder, the small intestine has trouble absorbing either macronutrients or micronutrients or in some cases, it is unable to absorb both these types of nutrients.^(1, 2, 3)

Since malabsorption impacts a person’s ability to absorb proper nutrients from food, it is important that the condition is diagnosed and treated at the earliest possible.

There can be many causes of malabsorption syndrome, including infections, certain health conditions, or even developmental issues. Here are some of the factors that may cause malabsorption syndrome:

• Long-term use of antibiotics.
• Damage to the intestine due to trauma or injury, surgery, inflammation, or infection.
• Lactase deficiency or lactose intolerance.
• Health conditions like celiac disease, Crohn’s disease, cystic fibrosis, or chronic pancreatitis.
• Parasitic diseases.
• Congenital irregularities or irregularities that are present at birth, such as biliary atresia, which is a condition where the bile ducts do not develop properly, preventing the flow of bile from the liver.^(4, 5)
• Radiation therapy that causes injury to the lining of the intestine.
• Diseases of the liver, pancreas, or gallbladder.
• Certain medications that cause injury to the intestinal lining, such as cholestyramine, tetracycline, or colchicine.

Digestive issues can also cause malabsorption syndrome. In some cases, the stomach is not able to manufacture the enzymes that are needed to digest certain foods. Or, it may also be that the body is not able to mix the food you consume with the acid and enzymes that are produced by the stomach.^(6, 7)

There are also some rare disorders that can also cause malabsorption syndrome, such as short bowel syndrome (SBS).^(8, 9) In people with short bowel syndrome, the small intestine is shortened, which makes it less capable of absorbing nutrients. This condition can either be caused due to surgery, or it might be present from birth itself.

There are also certain diseases that cause malabsorption syndrome, including tropical sprue, which is most prevalent in India, parts of Southeast Asia, and the Caribbean.^(10, 11) 

Another very rare cause of malabsorption syndrome can also be Whipple’s disease, which is caused by a bacterial infection.

If you have a family history of malabsorption syndrome or even cystic fibrosis, you are at a higher risk of developing the condition. Some of the other risk factors for this syndrome include:

• If you have had intestinal surgery
• If you drink large amounts of alcohol regularly.
• If you use certain medications like mineral oil or laxatives regularly.
• If you have traveled to India, the Caribbean, and some parts of Southeast Asia.

It is important to be aware of the symptoms of malabsorption syndrome. You start experiencing the symptoms of this condition when the unabsorbed nutrients pass through the digestive tract. Of course, the symptoms differ from person to person depending on which nutrients are not getting absorbed properly. Other signs and symptoms may also develop due to a deficiency of that nutrient, which is being caused due to poor absorption.

Here are some of the common symptoms you may experience if you are not able to absorb protein, fats, certain vitamins, or sugars:

• Protein: If you are suffering from protein malabsorption, you may notice signs like dry hair, fluid retention, and hair loss. Fluid retention, also known as edema, often appears like swelling.
• Fats: If you are unable to absorb fats, you are likely to have symptoms like foul-smelling stools that are bulky and soft, and light-colored. Such stools are difficult to flush and you may find them sticking to the side of the toilet bowl or just floating even after multiple flushes.
• Certain Vitamins: You are likely to have malnutrition, anemia, low blood pressure, weight loss, and muscle wasting over a period of time.
• Certain Types of Sugars: In this case, you are like to experience explosive diarrhea, bloating, or excessive gas.

Malabsorption is likely to affect people differently. For example, some people may stop menstruating, while children with malabsorption syndrome may not grow properly. Such children’s rate of weight gain or speed of weight gain is likely to be dramatically below that of other children of the same gender and age.^(12, 13)

In children, another symptom of malabsorption syndrome is that they are prone to avoiding certain foods.

Your doctor may suspect you have malabsorption syndrome in the following cases:

• If you have chronic diarrhea
• If there are any nutrient deficiencies that tend to persist.
• If there is dramatic weight loss without trying to lose weight and despite consuming a nutritious and well-balanced diet.

There are certain diagnostic tests that are used to confirm this diagnosis, including:

1. Stool Tests

   Stool tests are usually the first diagnostic test used to diagnose malabsorption syndrome. This is because stool tests are able to measure the fat present in the sample. Stool tests are also the most reliable diagnosing factor because fat is typically present in the feces or stool of a person who has malabsorption syndrome. ⁽¹⁴⁾

2. Blood Tests

   Blood tests are used to measure the levels of certain nutrients in the blood, including:

   • Calcium
   • Vitamin D
   • Vitamin B12
   • Albumin
   • Carotene
   • Iron
   • Folate
   • Phosphorus
   • Protein

   If the blood test indicates a deficiency in any of these nutrients, it does not necessarily mean that you automatically have malabsorption syndrome. However, it does mean that you are not consuming a nutritious and balanced diet. The normal level of these nutrients usually indicates that you do not have malabsorption syndrome.⁽¹⁵⁾

3. Breath Tests

   Breath diagnostic tests are usually used to check for lactose intolerance. If the body does not absorb lactose, it enters the colon. The bacteria present in the colon break down this lactose and manufacture hydrogen gas. The excess amount of hydrogen gets absorbed from the intestine into the blood and then into the lungs, where you exhale the gas.

   If there is hydrogen gas present in your breath after ingesting a lactose-containing food item, you are most likely to be lactose intolerant.^(16, 17)

4. Imaging Tests

   You might be prescribed certain imaging tests that will take pictures of your stomach or digestive system to search for any structural issues. For example, your doctor may tell you to get a CT scan done to see if there is any thickening of the small intestine wall, a typical sign of Crohn’s disease.⁽¹⁸⁾

5. Biopsy

   In some cases, your doctor might order a biopsy if they suspect the presence of abnormal cells in the small intestine lining. A biopsy is usually done through an endoscopy in which a thin tube is inserted into the mouth, passed through the esophagus, through the stomach, and then into the small intestine. A sample of cells is then collected from the lining of the small intestine.

Treatment for malabsorption syndrome is usually begun by trying to relieve the symptoms such as diarrhea. Medications like loperamide can help, and also, continue to hydrate yourself to prevent dehydration. Your doctor will look at replacing the nutrients and fluids that you are not able to absorb.^(19, 20)

The treatment primarily depends on the cause of your malabsorption syndrome. For example, if you are lactose intolerant, your doctor will recommend certain things like avoiding milk and dairy products, or you may have to take a lactase enzyme tablet.

Your doctor is also likely to refer you to a dietitian or nutritionist who will design a treatment plan to ensure that you are getting the nutrients that your body is unable to absorb. They may recommend some of the following:

• Dietary Changes: The first step in your treatment plan will be a change in your diet. Your dietitian will adjust your diet to either increase or decrease some nutrients or foods. For example, you may have to avoid or at least restrict the intake of foods that are high in fat to decrease diarrhea while increasing the consumption of foods that are high in potassium to help balance out the electrolyte levels in the body that are lost due to diarrhea.
• Vitamin Supplements: You will be advised to take high doses of some vitamins or other nutrients to make up for the vitamins or nutrients that are not getting absorbed by the intestine.
• Enzyme Supplements: Enzyme supplements will be recommended to help your body absorb those nutrients that it is unable to absorb on its own.

Malabsorption syndrome can cause many problems like weight loss, malnutrition, immune system deficiency, fatigue, and impaired wound healing. The complications of this condition depend on the severity of the underlying cause of malabsorption syndrome. This is a type of digestive disorder that prevents the body from absorbing nutrients from your food properly. There can be many causes of malabsorption syndrome, though most of them involve damage caused to the mucous lining of the small intestine, where most of the absorption process happens. If you have diarrhea that continues to persist quite some time, it is a good idea to consult your doctor to find out if you have malabsorption syndrome.

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