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Approaching the patient with chronic malabsorption syndrome
1Department of Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA.
Seminars in Gastrointestinal Disease
|November 5, 1999
Summary
Evaluating chronic malabsorption involves stool studies to detect fat malabsorption, followed by endoscopy or pancreatic function tests. Celiac sprue, a gluten intolerance, is a common cause diagnosed via diet response and biopsy.
Area of Science:
- Gastroenterology
- Internal Medicine
Background:
- Chronic malabsorption presents as decreased intestinal absorption or maldigestion.
- Common causes include celiac sprue and pancreatic insufficiency.
Observation:
- Initial evaluation requires stool studies to confirm fat malabsorption.
- Endoscopy with biopsies and bacterial cultures are typically performed if fat malabsorption is present.
- Pancreatic function assessment and small bowel radiography are indicated for normal endoscopic findings and no bile acid deficiency.
Findings:
- Celiac sprue is an immune-mediated gluten intolerance with genetic and environmental factors.
- While classic symptoms include malabsorption, milder cases may be overlooked.
- Diagnosis is confirmed by clinical and endoscopic improvement on a gluten-free diet.
- Serological markers offer high sensitivity and specificity, but duodenal biopsy is the gold standard.
- Intestinal lymphoma should be considered in refractory cases.
Implications:
- Accurate diagnosis of malabsorption is crucial for effective management.
- Early recognition of celiac sprue, even with subtle symptoms, can prevent long-term complications.
- Understanding diagnostic pathways aids clinicians in differentiating causes of malabsorption.