Malabsorption Syndromes
(Celiac Disease; Sprue; Whipple's Disease)
All malabsorption disorders involve an inability to absorb one or more nutrients from the small intestine into the bloodstream. Many conditions can cause this problem, and the specific nutrients that cannot be utilized vary according to the cause.
In a common form, celiac disease, a hereditary defect prevents a person from absorbing gluten, a protein found in wheat, rye, and to a lesser extent, other cereal grains. This disorder usually shows up at an early age, often when a baby starts eating solid foods, but it may not appear until adulthood.
People with the less common tropical sprue, seen mostly in the Caribbean, India, and Southeast Asia, usually cannot digest and absorb many foods. As a result, they suffer numerous vitamin and mineral deficiencies.
Whipple's disease, a rare intestinal disorder affecting mostly middle-aged men, also involves a variety of nutrients. For these people, intestinal abnormalities prevent proper absorption, but the underlying cause is unknown.
Typical symptoms include weight loss, flatulence, abdominal bloating, and sometimes diarrhea. Nutritional deficiencies caused by malabsorption can result in anemia, childhood growth problems, neurological symptoms, and other signs of deficiency diseases.
Diagnostic Studies and Procedures
When a malabsorption disorder is suspected, blood studies will be ordered to look for nutritional deficiencies. A stool sample will also be examined for a high fat content, a common finding.
If symptoms suggest celiac disease, tropical sprue, or Whipple's disease, a biopsy of the small intestine will be done to look for characteristic abnormalities in the intestinal villi, the tiny finger-like structures through which nutrients are absorbed. Other possible tests include X-rays and endoscopy, in which the intestinal tract is inspected through a fiberoptic viewing tube.
Medical Treatments
For malabsorption caused by another disease, the underlying problem will be tackled. Primary malabsorption syndromes are treated as follows:
Celiac disease requires scrupulous avoidance of foods that contain gluten (see Nutrition Therapy, below). Vitamin and mineral supplements are usually prescribed to counter nutritional deficiencies. Severely ill adults may need intravenous feeding. If dietary measures fail to improve absorption, prednisone or another steroid may be given to induce a remission.
Tropical sprue can be cured by several months of antibiotic therapy, even when there is no apparent bacterial infection. Folic acid and possibly other nutritional supplements may also be prescribed. Another round of antibiotics will be ordered if a relapse occurs.
Whipple's disease is also cured with antibiotics. A typical regimen calls for 10 to 14 days of a high-dose antibiotic such as penicillin, followed by 10 to 12 months of a lower dose Improvement is usually seen within two weeks, although full recovery may take two years. Recurrences are treated with renewed antibiotics.
Alternative Therapies
Nutrition Therapy. A clinical nutritionist or dietitian should be consulted. Sometimes diet is the sole treatment, especially for celiac disease, in which consuming even a small amount of gluten can produce symptoms. Gluten is widely used in processed foods, so labels must be checked carefully.
Self-Treatment
Self-care should be directed to preventing a flare-up by following your recommended diet. If diarrhea is a problem, increase fluids to prevent dehydration. Tea, apple juice, broth, and water are good choices for mild diarrhea. Eliminate solid foods until bowel function normalizes, then gradually resume a normal diet, starling with bland foods like rice, bananas, or mashed potatoes.
Other Causes of Malabsorption Symptoms
Irritable bowel syndrome, diverticulosis, food poisoning, stress, or simple indigestion can cause diarrhea and other symptoms of malabsorption.