Malabsorption syndrome

Malabsorption syndrome is a syndrome of impaired intestinal absorption. Clinical symptom complex due to impaired absorption through the mucosa of the small intestine of one or more nutrients.

Etiology and pathogenesis. Malabsorption syndrome may be primary (hereditary) or secondary (acquired). Etiology in each specific case is different (absence or decreased activity of lactase, alpha-glucosidase, enterokinase, etc.). Among the hereditary conditioned disturbed intestinal absorption, there are disaccharidase deficiency (lactase, sugary, isomaltase), true celiac disease (intolerance to gliadin), enterokinase insufficiency, intolerance to monosaccharides (glucose, fructose, galactose), impaired absorption of amino acids (cystinuria, Hartnup disease, etc.) A violation of absorption of vitamin B12 and folic acid, etc. Secondary, or acquired, malabsorption, is a companion of many chronic diseases of the stomach and intestines (pancreatitis, hepatitis, dysbacteriosis, intestinal infections of idiskinesia, Crohn's disease, etc.).

In the clinical picture, chronic diarrhea with a high content of lipids in the feces predominates in children. Gradually develops dystrophy, children are lagging behind in growth. Adhere manifestations of vitamin deficiency, violations of water-electrolyte balance (dry skin, seizures, glossitis, hypokapaemia, hyponatremia, hypocalcemia, etc.). Due to the development of hypoproteinemia, swelling may occur. Depending on the cause of the disturbed intestinal absorption, the disease can develop in the first months of life (for example, in the congenital absence of lactase) or much later, usually when transferring to artificial nutrition (intolerance to sucrose), etc.

The diagnosis of impaired intestinal absorption is easily suspected if long-lived diluted stool with a high fat content in the feces and practically uncontrollable by traditional means is observed.

Treatment in each case must be strictly etiological. So, with intolerance of sucrose from food, products containing sucrose, starch (sugar, potatoes, semolina), as well as products made of flour, are excluded from food. Over time, tolerance to sucrose increases and the diet expands. When lactose intolerance in mild cases is limited to a decrease in the amount of milk given and the early administration of sucrose and starch. In severe form, maternal and cow's milk is completely excluded and replaced with plant species (soybean, almond), protein hydrolysates are prescribed, etc. Cereals exclude cereals, and enzymatic preparations are widely used.

The basic position that must be maintained in malabsorption is to diagnose the disease as early as possible and begin treatment early, without allowing deep metabolic shifts. The prognosis with timely diagnosis and treatment is favorable. Prevention consists in dietotherapy with the exclusion of intolerable products.