Malabsorption is what? Classification and reasons

The small intestine is one of the intestine parts. It performs many functions, plays a major role in the processes of digesting food and absorbing nutrients. With the development of certain diseases, the work of this department is disrupted - malabsorption syndrome is manifested, which is abbreviated as CMA. What is this term? What are the causes of this syndrome?

Explanation of the concept

In the medical literature one can find a term such as "malabsorption". This word is used to denote a violation of absorption of the intestinal mucosa of food components. There is also a term like "maldigestia". This is a violation of the processes of conversion of fats, proteins and carbohydrates into absorbed cleavage products.

Specialists combine both of the above terms ("malabsorption" and "maldigestia") when talking about malabsorption syndrome. This is how a complex of clinical manifestations emerged due to violations of cavitary, parietal, membrane digestion and transport in the small intestine. Because of the changes taking place in the human body due to the appearance of malabsorption syndrome, metabolic disorders occur. People begin to suffer unpleasant symptoms.

The causes of the appearance of AGR

Malabsorption syndrome is observed in many congenital and hereditary diseases, in which the absorption of substances is impaired, the activity of enzymes decreases. An example is cystic fibrosis. In this disease, SMA develops due to a decrease in the activity of pancreatic enzymes and a violation of the viscosity of secrets.

Malabsorption syndrome is caused by diseases caused by infections and parasites, anomalies of the lymphatic and circulatory systems. SMA is also observed with damage to the small intestine and a decrease in the area of absorption (these changes that have occurred in the body cause serious violations of many types of metabolism, physical and mental retardation in development).

Thus, malabsorption is a set of unpleasant symptoms, which can cause a huge number of different causes. They can be combined as follows:

1. Preenteral group. This includes diseases of the biliary tract, liver, stomach, cystic fibrosis.
2. Postnatal group. It includes disorders of lymph circulation and circulation in the longest part of the intestine, which is located between the stomach and the large intestine, exudative enteropathy, lymphosarcoma, and lymphogranulomatosis.
3. Enteral group of reasons. This includes galactose malabsorption, celiac disease, disaccharidase insufficiency, giardiasis, herpetiform dermatitis.

Symptoms typical for SMA

Despite the fact that malabsorption syndrome is inherent in various diseases, it is possible to distinguish signs characteristic of it. With AGR, nausea and vomiting occur. At patients the appetite worsens. Symptoms such as flatulence, a change in stool (most often diarrhea) also occur. All these signs are called a dyspeptic syndrome. He is leading in the clinical manifestations of SMA.

Particular attention deserves a chair. Assessing the characteristics of fecal masses, specialists receive important information that allows them to make the correct diagnosis:

• A liquid and foamy stool with an acidic odor is a symptom that can be inherent in pathologies such as glucose-galactose malabsorption, disaccharidase insufficiency;
• Fatty stool can occur with chronic pancreatitis, cystic fibrosis, herpetiform dermatitis, exudative enteropathy, Pearson's syndrome, intestinal dysbacteriosis;
• Very fatty stool is observed in cystic fibrosis, congenital lipase insufficiency;
• Water diarrhea - a symptom that can occur when the enter the infection, develops enterocolitis, malabsorption of glucose and galactose.

When SMA sometimes there are pain. Most often they are caused by intestinal infections and invasions. Pain syndrome can be observed after eating dairy products. He combined with a frothy stool with a sour smell, flatulence indicates lactase deficiency. Pain in the abdominal area with AGA accompanies food allergy, bowel abnormalities, Whipple's disease, ulcerative colitis, Crohn's disease. In the syndrome of malabsorption, the following symptoms are still observed:

• Rashes on the skin;
• Fatigue;
• Sensation of weakness;
• Bloating;
• anorexia.

Malabsorption in children is accompanied by scarce syndromes. Physical development is disrupted. This is manifested in a decrease in body weight, development of hypotrophy, growth retardation. The deficiency of vitamins is indicated by the state of the skin. The skin becomes dry, begins to peel off. On it there are pigmented spots. The hair becomes thinner and begins to fall out. Nails get a dull shade and exfoliate. When calcium deficiency occurs, cramps, pain in the muscles and bones. The lack of iron, copper and zinc leads to the appearance of skin rashes, the development of iron deficiency anemia, increased body temperature.

Existing classifications

The syndrome of malabsorption combines more than 70 different diseases. In this regard, specialists face some difficulties in the preparation of classifications. The most successful is the division into hereditary and acquired syndromes of malabsorption:

1. The first of them is revealed in 10% of cases. Hereditary SMA is transmitted to the child from the parents. It also happens due to gene mutations.
2. Acquired malabsorption syndrome is the result of the development of intestinal and extraintestinal diseases (for example, tumors, immunodeficiency states, liver and pancreas diseases).

There is also a classification based on the severity of malabsorption syndrome:

• I degree (mild form) - children have a slightly reduced body weight, there are signs of multivitamin deficiency, there is a disharmonious physical development;
• II degree (middle form) - the patients have a body mass deficit (deviation from the norm is more than 10%), there is a lag in physical development, there are pronounced signs of a deficiency of electrolytes and multivitamin deficiency;
• III degree (severe form) - children are physically underdeveloped, body weight deficiency exceeds 20%, in some patients a delay in psychomotor development is observed.

Types of malabsorption

In 1977, the VIII World Congress of Gastroenterologists was held. On it specialists have identified several types of malabsorption, depending on the causes that cause it:

• Intracavitary;
• Postcellular;
• Enterocellular.

Lack of bile and secreted by the pancreas, affecting the cavity digestion and causing its violation, is malabsorption of the intracavitary type. In babies, they arise from cystic fibrosis, congenital hypoplasia of the pancreas. In older children, the appearance of intracavitary malabsorption syndrome provokes such diseases as cirrhosis of the liver, chronic pancreatitis.

The second type of SMA is postcellular malabsorption. This syndrome, which is characterized by the loss of plasma protein through the wall of the intestine. It is observed in abnormalities of the circulatory and lymphatic system. One of the diseases is idiopathic intestinal lymphangiectasia. She has a severe loss of calcium, lipids and proteins in the gastrointestinal tract.

The enterocellular type unites those cases when membrane digestion or absorption is disturbed due to a defect in the enzyme systems of epithelial cells of the intestine. This can be observed in young children because of hereditary diseases associated with the violation:

• Absorption;
• Membrane digestion;
• Digestion and absorption.

In infants, the enterocellular type of malabsorption syndrome occurs due to damage and death of intestinal cells due to the influence of infections or parasites, tuberculosis, small bowel tumors, Crohn's disease.

Examples of intracavitary malabsorption

At this type of AGR, the digestion of fats is more violated. Their hydrolysis is carried out by lipase of the pancreas, which is activated by bile. With a lack of these substances, a symptom such as steatorrhoea appears . This is the release of excess fat from the feces. The most vividly manifested steatorrhoea in chronic pancreatitis. Less noticeable is this symptom in diseases of the liver and biliary tract.

Among the causes of intracavitary malabsorption, it is worth considering congenital hypoplasia of the pancreas (hypoplasia). Symptoms occur from the first days or weeks of life. There is a liquid, abundant, quickened stool with an unpleasant odor and a greasy shine. Fat can even leak constantly from the anus.

Examples of postcellular malabsorption

Postcellular malabsorption of the intestine is observed with exudative enteropathy. This is a syndrome in which plasma protein is lost through the mucous membrane. The cause of exudative enteropathy can be the presence of a congenital malformation of the lymph vessels of the intestine. Most often, the syndrome causes diseases of Whipple, Crohn, small bowel tumors, food allergies.

Exudative enteropathy sometimes occurs without obvious clinical manifestations. Symptoms such as diarrhea and steatorrhea may occur. Patients develop peripheral edema, localized on the face, lower back, perineum, extremities.

Examples of Enterocellular Malabsorption

Enterocellular type of SMA with impaired absorption can be caused by a pathology such as glucose-galactose malabsorption. This is a hereditary disease in which the active transport of galactose and glucose in the mucosa of the small intestine is disturbed. The ailment from the first days of life is manifested by diarrhea. Fecal masses are allocated from 10 to 20 times per day. They are watery, reminiscent of urine. The child's body temperature rises, vomiting occurs. With the abolition of dairy nutrition, the symptoms go away. Poor tolerance of sweets and milk remains for life.

Another example of enterocellular CMA is a violation of the absorption of fructose. This is a rare genetic malabsorption. Symptoms occur after eating fruits and juices containing a large amount of fructose in their composition. This and apples, and oranges, and cherries, and cherries. That fructose, which is not absorbed by the body, causes flatulence, watery diarrhea, colicky pain in the abdomen. In some cases, vomiting occurs. The severity of the symptoms depends on the amount of fructose that has got into the body.

The most common cause of enterocellular malabsorption with a violation of membrane digestion is a disaccharidase insufficiency. With it, disaccharides are not completely cleaved. They are not absorbed when entering the distal parts of the intestine and are subjected to bacterial fermentation with the release of hydrogen. There are attacks of intestinal colic, bloating, diarrhea, decreased appetite, regurgitation, vomiting.

Enterocellular malabsorption of the intestine with impaired absorption and digestion can be observed with celiac disease. This is a chronic hereditary disease in which the villi of the small intestine are damaged by certain food products. Celiac disease occurs in children several months after the introduction of gluten-containing foods into the diet. When the disease:

• The frequency of defecation is 2 to 5 times a day;
• Fecal masses are mushy, sometimes foamy, they have a fetid odor, a greasy shine;
• The abdomen increases;
• There are insufficient weight increases (after a while, a deficit of growth is added to the mass deficit).

Performing the diagnosis of malabsorption syndrome

Diagnosis of malabsorption is not carried out. Specialists in the identification of symptoms of SMA prescribe to their patients the delivery of special tests and tests to confirm any suspected pathology that provoked a violation of absorption or digestion.

When conducting diagnostics, doctors are guided by the following algorithm developed by the World Gastroenterological Organization:

• First, a careful history is collected, information is collected about the medications taken, recent travel, eating and drinking, which are not part of the usual diet;
• The hereditary anamnesis is studied;
• A physical examination is performed to identify signs of malabsorption;
• Studied stool masses, taking into account their characteristics;
• Laboratory tests are conducted to obtain additional information.

Further diagnosis of malabsorption syndrome includes the performance of studies with suspicion of celiac disease, the presence of lamblia, bacteria and parasites in the body. Important diagnostic information allows you to obtain an ultrasound examination of the internal organs of the abdominal cavity. Thanks to ultrasound, it is possible to assess the condition of the liver, pancreas, gall bladder, lymph nodes.

To exclude or confirm autoimmune gastritis, celiac disease, Crohn's disease, esophagogastroduodenoscopy with biopsy of the stomach and duodenum is necessary. To confirm the insufficiency of the exocrine function of the pancreas, feces, computer and magnetic resonance imaging, retrograde cholangiopancreatography for the visualization of ducts are performed. To find out about the presence or absence of ileum damage, specialists prescribe ileocolonoscopy with a biopsy from the area under investigation and the colon.

Treatment for malabsorption syndrome

After diagnosing the cause of malabsorption, the doctor prescribes etiotropic treatment aimed at eliminating the detected disease. For example:

• If celiac disease is detected, the specialist recommends the patient a lifelong agglutinous diet;
• If malabsorption of carbohydrates or food intolerance is detected, then an appropriate elimination or restrictive diet is prescribed;
• At infectious processes treatment with antibiotics is shown;
• With metabolic and endocrine diseases requires appropriate pathogenetic therapy.

With severe diarrheal syndrome, which causes malabsorption, the treatment can be etiological, pathogenetic and symptomatic. Etiological and pathogenetic therapy can be the following means:

• Antibiotics for bacterial diarrhea;
• "Metronidazole" with amoebiasis;
• Anthelmintnyh drugs for helminthiases;
• Glucocorticoids, cytostatics, "Infliximab" in inflammatory bowel diseases;
• "Tetracycline", "Ceftriaxone", "Co-trimoxazole" with Whipple's disease;
• "Octreotide" with endocrine tumors of the gastrointestinal tract.

Symptomatic treatment includes taking probiotics, opiates, Loperamide, adsorbing agents (bismuth preparations, Diosmectite).

Do self-medication when symptoms of SMA can not. It will not give positive results. In addition, malabsorption is a manifestation of serious and dangerous diseases. If there are signs of AGR, it is recommended that you consult a doctor. Only a specialist can name the true cause of the syndrome and prescribe an effective therapy to eliminate the diagnosed disease.