Malabsorption

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Malabsorption

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Overview

Classification

Infection
Structural defect
Digestive failure
Systemic disease
Iatrogenic

Differentiating Malabsorption from other Diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

Malabsorption is a condition which is associated with impaired absorption of one or all dietary nutrients. There are multiple etiologies with diminished intestinal absorption. Many of them present with diarrhea, especially steatorrhea. They might have malabsorption of carbohydrates, fat, protein, vitamins, and/or minerals. Malabsorption is occurred following intestinal mucosal or structural defects. Malabsorption according to etiology may be classified into five main groups including infection, structural defect, digestive failure, systemic disease, and iatrogenic causes. Different workups might be used to differentiate diagnosis of malabsorption including small bowel biopsy, stool exam, breath testings, lab findings, and imagings.

Classification

Malabsorption according to etiology may be classified into five main groups:[1][2]

Malabsorption classification
Infection
Viral HIV
Bacterial Tuberculosis
Tropical sprue
Whipple's disease
Small intestinal bacterial overgrowth syndrome
Parasitic Giardia
Isospora
Structural or enzyme defect
Blind loop syndrome
Fistula
Diverticula
Stricture
Lactase deficiency
Digestive failure
Pancreatic insufficiency Cystic fibrosis
Chronic pancreatitis
Pancreatic cancer
Zollinger–Ellison syndrome
VIPoma
Carcinoid syndrome
Bile acid malabsorption
Systemic disease
Celiac disease
Inflammatory bowel disease Crohn's disease
Ulcerative colitis
Infiltrative disorders Amyloidosis
Lymphoma
Eosinophilic gastroenteritis
Endocrine abnormalities Diabetes mellitus
Hypothyroidism
Hyperthyroidism
Hyperparathyroidism
Hypoparathyroidism
Addison's disease
Immunologic disorders Common variable immunodeficiency
Abetalipoproteinemia
Iatrogenic
Medication
Radiation
Post surgery Gastrectomy
Bariatric surgery
Short bowel syndrome

Differentiating malabsorption from other Diseases

To review the differential diagnosis of diarrhea, click here.

The following table outlines the major differential diagnoses of malabsorption.[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]

Categories Cause Clinical manifestation Lab findings
Symptoms Findings
Duration Diarrhea Fever Abdominal pain Weight loss
Stool exam CBC
Acute Chronic Watery Bloody Fatty WBC Hgb Plt
Gastrointestinal Crohn's disease + + + + ± + + WBC +

RBC +

Ulcerative colitis + + + + ± + + WBC +

RBC +

Celiac disease + ± ± + + Fat droplets on sudan stain Nl Nl
Cause Duration Diarrhea Fever Abdominal pain Weight loss Findings Stool exam CBC
Acute Chronic Watery Bloody Fatty WBC Hgb Plt
Cystic fibrosis + + ± + + Fat droplets on sudan stain Nl Nl
Chronic pancreatitis + + + + + Fat droplets on sudan stain

Fecal elastase +

Nl Nl Nl
Bile acid malabsorption + + + + Fat droplets on sudan stain Nl Nl Nl
Lactose intolerance + + + + Nl Nl Nl
Infection Bacterial Cause Duration Diarrhea Fever Abdominal pain Weight loss Findings Stool exam CBC
Acute Chronic Watery Bloody Fatty WBC Hgb Plt
Whipple's disease + + + ± + + Fecal fat + ↓/↑
Tropical sprue + + + + + + + WBC +

Stool culture +

Nl Nl
Small bowel bacterial overgrowth + + + + + WBC +

Stool culture +

Fecal fat +

Nl Nl
Cause Duration Diarrhea Fever Abdominal pain Weight loss Findings Stool exam CBC
Acute Chronic Watery Bloody Fatty WBC Hgb Plt
Virus HIV + + + + + WBC + Nl
Parasite Giardia + + + + + Ova + Nl Nl Nl
Isospora + + + + + + + WBC +

RBC +

Ova +

Fecal fat +

Nl Nl
Tumors VIPoma + + + + + + Nl Nl Nl
Zollinger–Ellison syndrome + + + + + + Nl Nl
Cause Duration Diarrhea Fever Abdominal pain Weight loss Findings Stool exam CBC
Acute Chronic Watery Bloody Fatty WBC Hgb Plt
Lymphoma + + + + + + RBC + Nl Nl
Medication/Toxicity + + + ± ± + + Nl Nl
Iatrogenic Short bowel syndrome + + + + + Fecal fat + Nl
Radiation enteritis + + + + + + + WBC +

RBC +

Fecal fat +

Nl Nl
Others Cause Duration Diarrhea Fever Abdominal pain Weight loss Findings Stool exam CBC
Acute Chronic Watery Bloody Fatty WBC Hgb Plt
Abetalipoproteinemia + + + + + Nl Nl Nl
Hyperthyroidism + + ± + +
  • Lump in the neck
Fecal fat + Nl Nl Nl
Diabetic neuropathy + + + + + Fecal fat + Nl Nl
Systemic sclerosis + + ± + + + RBC +

Fecal fat +

Nl Nl

References

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