Overview of the treatment of malabsorption
- Joel B Mason, MD
Joel B Mason, MD
- Professor of Medicine and Nutrition
- Tufts University Schools of Medicine and Nutrition
- USDA Human Nutrition Research Center at Tufts University
- Vladan Milovic, MD, PhD
Vladan Milovic, MD, PhD
- Associate Professor of Medicine
- Head, Department of Gastroenterology & Oncology Reha-Zentrum Bad Reichenhall /
- Bayerisch Gmain Klinik Hochstaufen Bayerisch Gmain
- Bayern, Germany
Malabsorption refers to impaired absorption of nutrients . It can result from congenital defects in the membrane transport systems of the small intestinal epithelium (primary malabsorption) or from acquired defects in the epithelial absorptive surface (secondary malabsorption). Another factor that can interfere with nutrient absorption is maldigestion, which is due to impaired digestion of nutrients within the intestinal lumen or at the terminal digestive site of the brush border membrane of mucosal epithelial cells.
Although malabsorption and maldigestion are pathophysiologically different, the processes underlying digestion and absorption are interdependent, so that in clinical practice, the term malabsorption has come to denote derangements in either process.
This topic review will provide an overview of the treatment of malabsorption. Issues that are relevant to specific diseases (eg, pancreatic insufficiency, celiac disease, and short bowel syndrome) are discussed in detail in the appropriate topic reviews. The clinical manifestations, diagnosis, and pathophysiology of malabsorption are discussed separately. (See "Clinical features and diagnosis of malabsorption" and "Mechanisms of nutrient absorption and malabsorption".)
Three steps are required for normal nutrient absorption :
●Luminal events (referred to as the "Luminal" phase)
- Greenberger NJ. Celiac sprue and other malabsorptive disorders. In: Therapy of Digestive Disorders, Wolfe MM (Ed), Saunders, Philadelphia 2006. p.711.
- Farrell JJ. Digestion and absorption of nutrients and vitamins. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed, Feldman M, Friedman L, Brandt L (Eds), Saunders Elsevier, Philadelphia 2006. p.2147.
- Hogenauer C, Hammer HF. Maldigestion and malabsorption. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed, Feldman M, Friedman L, Brandt L (Eds), Saunders Elsevier, Philadelphia 2006. p.2199.
- Gruy-Kapral C, Little KH, Fordtran JS, et al. Conjugated bile acid replacement therapy for short-bowel syndrome. Gastroenterology 1999; 116:15.
- Kapral C, Wewalka F, Praxmarer V, et al. Conjugated bile acid replacement therapy in short bowel syndrome patients with a residual colon. Z Gastroenterol 2004; 42:583.
- Heydorn S, Jeppesen PB, Mortensen PB. Bile acid replacement therapy with cholylsarcosine for short-bowel syndrome. Scand J Gastroenterol 1999; 34:818.
- Emmett M, Guirl MJ, Santa Ana CA, et al. Conjugated bile acid replacement therapy reduces urinary oxalate excretion in short bowel syndrome. Am J Kidney Dis 2003; 41:230.
- Jeppesen PB, Gilroy R, Pertkiewicz M, et al. Randomised placebo-controlled trial of teduglutide in reducing parenteral nutrition and/or intravenous fluid requirements in patients with short bowel syndrome. Gut 2011; 60:902.
- O'Keefe SJ, Jeppesen PB, Gilroy R, et al. Safety and efficacy of teduglutide after 52 weeks of treatment in patients with short bowel intestinal failure. Clin Gastroenterol Hepatol 2013; 11:815.
- Johnston SD, Watson RG, McMillan SA, et al. Preliminary results from follow-up of a large-scale population survey of antibodies to gliadin, reticulin and endomysium. Acta Paediatr Suppl 1996; 412:61.
- Williams SE, Seidner DL. Metabolic bone disease in gastrointestinal illness. Gastroenterol Clin North Am 2007; 36:161.
- Mishkin S. Dairy sensitivity, lactose malabsorption, and elimination diets in inflammatory bowel disease. Am J Clin Nutr 1997; 65:564.
- Jeppesen PB, Mortensen PB. The influence of a preserved colon on the absorption of medium chain fat in patients with small bowel resection. Gut 1998; 43:478.
- Woolf GM, Miller C, Kurian R, Jeejeebhoy KN. Diet for patients with a short bowel: high fat or high carbohydrate? Gastroenterology 1983; 84:823.
- Gibson PR, Newnham E, Barrett JS, et al. Review article: fructose malabsorption and the bigger picture. Aliment Pharmacol Ther 2007; 25:349.
- Choi YK, Johlin FC Jr, Summers RW, et al. Fructose intolerance: an under-recognized problem. Am J Gastroenterol 2003; 98:1348.
- Ravich WJ, Bayless TM, Thomas M. Fructose: incomplete intestinal absorption in humans. Gastroenterology 1983; 84:26.
- Rumessen JJ, Gudmand-Høyer E. Functional bowel disease: malabsorption and abdominal distress after ingestion of fructose, sorbitol, and fructose-sorbitol mixtures. Gastroenterology 1988; 95:694.
- Nelis GF, Vermeeren MA, Jansen W. Role of fructose-sorbitol malabsorption in the irritable bowel syndrome. Gastroenterology 1990; 99:1016.
- Skoog SM, Bharucha AE. Dietary fructose and gastrointestinal symptoms: a review. Am J Gastroenterol 2004; 99:2046.
- Rao SS, Attaluri A, Anderson L, Stumbo P. Ability of the normal human small intestine to absorb fructose: evaluation by breath testing. Clin Gastroenterol Hepatol 2007; 5:959.
- Shepherd SJ, Parker FC, Muir JG, Gibson PR. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepatol 2008; 6:765.
- Rumessen JJ, Gudmand-Høyer E. Absorption capacity of fructose in healthy adults. Comparison with sucrose and its constituent monosaccharides. Gut 1986; 27:1161.
- Johlin FC Jr, Panther M, Kraft N. Dietary fructose intolerance: diet modification can impact self-rated health and symptom control. Nutr Clin Care 2004; 7:92.
- Bruno MJ, Haverkort EB, Tytgat GN, van Leeuwen DJ. Maldigestion associated with exocrine pancreatic insufficiency: implications of gastrointestinal physiology and properties of enzyme preparations for a cause-related and patient-tailored treatment. Am J Gastroenterol 1995; 90:1383.