Malabsorption Syndrome: Causes & Treatment Options

Are you experiencing digestive issues or unexplained weight loss? You might be suffering from malabsorption, a condition in which your body has trouble absorbing nutrients from food. This article will explore the causes, symptoms, and treatments of malabsorption, offering valuable insights to empower you in managing this condition effectively and enhancing your overall well-being.

What Is Malabsorption? 

Malabsorption syndrome is an umbrella term for a wide range of disorders in which the body cannot absorb nutrients from the digestive system (the small intestine) into the bloodstream. Nutrient absorption is essential for energy production and cell growth in every body part.

The symptoms can include difficulty absorbing all nutrients or problems absorbing specific nutrients. Nutrients in food include:

• Macronutrients (carbohydrates, proteins, fats)

• Micronutrients (vitamins and minerals)

The short-term impact of malabsorption is gastrointestinal distress due to undigested food in the gastrointestinal tract. Over time, malabsorption can lead to nutrient deficiencies. Macronutrient deficiencies can lead to malnutrition, muscle wasting, and decreased immunity, leading to frequent infection. Micronutrient deficiencies can affect many bodily functions and organs.

Causes of Malabsorption

Malabsorption syndrome has many causes, including intestinal mucosal injury, low pancreatic enzyme levels, infections, and intestinal surgery that shortens the length of the bowel.

Damage to the Intestinal Mucosa

Malabsorption syndrome occurs in conditions that damage the small intestine's mucosa (inner lining), where nutrients are absorbed. Examples of such conditions include:

• Enteritis (inflammation of the small bowel)

• Inflammatory bowel disease (Crohn’s disease and ulcerative colitis)

• Infections such as tropical sprue and Whipple’s disease

• Autoimmune disorders such as celiac disease

• Zolinger-Ellison syndrome (a rare disorder in which there is overproduction of stomach acid)

• Alcohol use disorder

Medical and Surgical Treatments

• Short bowel syndrome (lack of healthy, functional small intestine due to missing or damaged intestine, for example, after surgical removal)

• Cancer treatments (chemotherapy and radiation therapy)

• Overuse of certain medications, such as neomycin, cholestyramine, antacids, laxatives, colchicine, and oral diabetes medicines

Digestive Diseases

The liver, gallbladder, and pancreas play essential roles in digestion. The pancreas makes digestive enzymes that help to break down food. The liver and gallbladder make and store bile needed for fat digestion. Diseases in these organs can prevent food from being digested and absorbed properly. Examples of conditions that can lead to malabsorption syndrome include:

• Liver disease

• Gallbladder disease

• Bile duct blockage

• Chronic pancreatitis

• Pancreatic exocrine insufficiency

• Cystic fibrosis

Lymphatic Conditions

The body absorbs fats through the lymphatic system in the intestines. Conditions such as intestinal lymphangiectasia (abnormally dilated lymph vessels) and lymphoma (cancer) can lead to malabsorption of fats.

Food Intolerances

Some people are born lacking the digestive enzymes needed to digest certain sugars, which are called brush-border enzymes. For example, those with lactose intolerance have problems digesting lactose, a sugar in certain foods like milk and dairy products. Similarly, people with fructose malabsorption have trouble absorbing fructose, a sugar in fruits.

Bacteria, Viruses, and Parasites   

Certain gastrointestinal tract infections, such as parasitic infections like giardiasis or worms, can lead to malabsorption. 

Small intestinal bacterial overgrowth (SIBO) is when bacteria from the colon (large intestine) enter the small intestine. This can lead to an imbalance between healthy and harmful gut bacteria. The bacteria can release toxins that damage the intestinal mucosa, which can lead to malabsorption.

Malabsorption can also occur in people with viral infections such as HIV/AIDS.

Other Causes

Studies have found that 50-60% of people with congestive heart failure have fat malabsorption. The reason for this is unclear but may be related to digestive system circulation.

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Malabsorption Symptoms    

Digestive Symptoms

In the short term, malabsorption syndrome can cause digestive symptoms such as:

• Gas

• Abdominal bloating or abdominal distention

• Abdominal pain 

• Abdominal discomfort

• Nausea

• Vomiting

• Diarrhea

• Fatigue

• Weight loss

• Steatorrhea (fatty stools that are greasy, pale colored, and foul smelling)

Other Symptoms

Over time, malabsorption of macronutrients (protein, fat, or carbohydrate malabsorption) can lead to malnutrition, with signs and symptoms such as:

• Unexplained weight loss (losing weight without trying)

• Muscle wasting

• Easy bruising

• Frequent infections

• Dry skin and other skin problems

• Dry, brittle hair and hair loss

• Edema (swelling)

• Anemia (pale skin, weakness, fatigue)

• Dehydration (increased thirst, dark urine)

• Fatigue

• Emotional changes such as irritability

• Amenorrhea (skipped periods or stopped periods in women) 

• Delayed growth in children

Symptoms of Vitamin and Mineral Deficiencies

Malabsorption of certain nutrients called micronutrients can lead to deficiencies of vitamins and minerals with a wide range of symptoms. Symptoms of malabsorption due to not getting enough nutrients may include:

• Weak bones, bone pain, and bone fractures (calcium and vitamin D deficiency) 

• Nosebleeds and bleeding gums (vitamin K deficiency)

• Trouble with night vision (vitamin A deficiency)

• Mouth sores (vitamin B12 and folate deficiency)

• Pale skin, fatigue, weakness, dizziness (iron deficiency anemia)

Malabsorption Diagnosis and Testing  

Blood Tests 

Blood tests can check blood levels of specific nutrients or markers of particular diseases, such as celiac disease.

Breath Tests

A lactose hydrogen breath test can help diagnose lactose intolerance and small intestinal bacterial overgrowth.

Stool Tests

Stool tests can help diagnose parasitic infections, pancreatic insufficiency, and fat malabsorption by measuring fecal fat.

Sweat Tests

A sweat test or sweat chloride test is a specific diagnostic test for cystic fibrosis. It measures chloride levels in sweat, which are elevated in people with CF.

Imaging Tests

Healthcare providers can perform several imaging tests to examine internal organs in the digestive system. These include X-rays, capsule endoscopy, and endoscopic ultrasound.

Intestinal Biopsy

During an endoscopic exam, your doctor may perform a biopsy (take a small sample of tissue from the small intestine for examination in the laboratory) to look for evidence of damage.

SeHCAT  

SeHCAT is a diagnostic nuclear medicine imaging test for bile acid malabsorption (see below for more information on this condition). It involves swallowing a capsule containing a radioactive tracer and a synthetic bile acid called SeHCAT. On days 1 and 7, a gamma camera detects the tracer and SeHCAT in the body. Less than 85% SeHCAT remaining in the body after 7 days indicates bile acid malabsorption. 

Fecal BA Test

This specialized test for bile acid malabsorption checks for bile acids in stool. 

Differentiating Between Other Conditions  

Malabsorption Syndrome vs Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome is a gastrointestinal disorder that causes symptoms such as gas, bloating, abdominal pain, stomach cramps, diarrhea, and constipation. These symptoms can resemble those caused by malabsorption syndrome. However, IBS does not usually result in malabsorption of nutrients.

Malabsorption Syndrome vs Bile Acid Malabsorption

Bile acid malabsorption is a digestive condition that causes chronic diarrhea. It occurs when bile salts (bile acids) are not adequately absorbed in the small intestine and pass into the colon (large intestine), triggering diarrhea symptoms. Bile acids help digest fat. They are released by the gallbladder and, in healthy people, reabsorbed from the intestinal tract, returned to the liver, and recycled into bile. Your doctor can use SeHCAT and fecal BA tests to diagnose this condition.

How is Malabsorption Syndrome Treated?  

According to the National Institute of Diabetes and Digestive and Kidney Diseases, treatment of malabsorption syndrome consists of:

• Treating the underlying cause

• Correcting nutrient deficiencies

• Avoiding dietary triggers

• Relieving symptoms such as diarrhea

Dietary Adjustments and Lifestyle Changes 

Some conditions that cause malabsorption can be treated with dietary adjustments and lifestyle changes. For example, lactose intolerance can be treated by avoiding or limiting dairy intake. In addition, lactase supplements are available to help digest lactose.

Medical Treatments

People who are malnourished and underweight due to malabsorption of fats, carbohydrates, proteins, and other nutrients may need supplemental nutrition with an oral formula, through a feeding tube, or through a vein (intravenously). This is necessary to provide nutrients to the body and support weight gain.

Medical treatments may also include supplements, medications, and procedures, such as:

• Bile acid sequestrants for bile acid malabsorption 

• Digestive enzymes for pancreatic exocrine insufficiency

• Antibiotics for bacterial infections

• Supplements to replace vitamins and minerals

• Procedures such as an endoscopic retrograde cholangiopancreatography (ERCP) for bile duct blockage

Managing Chronic Symptoms

Sometimes, there is no cure for the underlying cause of malabsorption syndrome, and it doesn’t go away. However, doctors can offer treatments to control the condition, and lifestyle adjustments can help relieve chronic symptoms.

Monitoring and Long-Term Care

Treating malabsorption syndrome can be complex. People with this condition need to keep all medical and laboratory appointments. Close follow-up and monitoring can ensure that impaired absorption is treated in time to avoid malnutrition, nutrient deficiencies, and other health complications.

FAQs on Malabsorption and Bile Issues  

What Should I Eat If I Have Malabsorption?

Dietary adjustments will depend on the underlying cause of malabsorption. You should work with your doctor and dietitian to develop a healthy eating plan. Your healthcare providers may recommend increasing or decreasing certain foods or nutrients in your diet. For example, they may advise limiting or avoiding high-fat foods or eating

 more calcium-rich foods. Following the dietary recommendations and treatment plan will ensure the body gets the nutrients it needs to function and keep your malabsorption symptoms in control.

How Do I Fix Fat Malabsorption?

Treating the underlying cause of fat malabsorption can fix it. Possible causes include pancreatic insufficiency, chronic pancreatitis, gallstone pancreatitis, pancreatic cancer, alcohol use disorder, cystic fibrosis, Zolinger-Ellison syndrome, bile or liver disease, small intestinal bacterial overgrowth, infections, and others.

What Autoimmune Diseases Cause Malabsorption?

Autoimmune diseases that can cause malabsorption include cystic fibrosis, celiac disease, and inflammatory bowel disease (Crohn’s disease and ulcerative colitis).

What Color Is Poop With Bile Malabsorption?

Bile malabsorption causes steatorrhea or fatty stools. The stool (poop) is typically pale in color (like clay). It is also looser and smellier and may float in the toilet bowl.

Why Is My Poop Yellow Liquid Bile?

Yellow liquid stool resembling bile can indicate fat absorption problems or bile flow. Problems with the liver, pancreas, or gallbladder can cause these. 

How To Reduce Bile Acids In The Body?

A low-fat diet can reduce the amount of bile acids your body makes. 

How Much Bile In Stool Is Normal?

Usually, a small amount of bile is excreted in stool. Bile is a yellow-green liquid that helps in fat digestion. It gives stool the typical brown color.

What Are The Symptoms of Bile Insufficiency?

Bile insufficiency (lack of enough bile) can occur in people with rare genetic conditions called bile acid synthesis disorders. These disorders can cause symptoms such as cholestasis (suppressed flow of bile from the liver) and malabsorption of fat-soluble vitamins A, D, E, and K. Treatment consists of bile acid replacement therapy to prevent serious complications like cirrhosis and liver failure.

How Do You Fix Bile Malabsorption?

The primary treatment for bile acid malabsorption is taking medications called bile acid binders or bile acid sequestrants, for example, cholestyramine, colestipol, and colesevelam.

How Long Does It Take For Malabsorption To Go Away?

It depends on the underlying cause. Some causes are more easily treatable than others. Discuss the prognosis with your healthcare team for more information.