The small intestine is one of the intestines. It performs many functions, plays a major role in the processes of digestion and absorption of nutrients. With the development of some diseases, the work of this department is disrupted - malabsorption syndrome manifests itself, which is abbreviated as SMA. What is this term? What causes this syndrome?
Deciphering the concept
In the medical literature you can find a term such as "malabsorption". This word is used to indicate malabsorption of the intestinal mucosa of food components. There is also a term such as "maldigestion." This is a violation of the processes of conversion of fats, proteins and carbohydrates into absorbable cleavage products.
Specialists combine both of the above terms ("malabsorption" and "maldigestion") when they talk about malabsorption syndrome. This is the set of clinical manifestations that arose due to disorders of the abdominal, parietal, membrane digestion and transport in the small intestine. Due to changes in the human body due to the appearance of malabsorption syndrome, metabolic disorders occur. Unpleasant symptoms begin to torment people.
Causes of SMA
Malabsorption syndrome is observed in many congenital and hereditary diseases, in which the absorption of substances is impaired, the activity of enzymes decreases. Cystic fibrosis is an example. In this disease, SMA develops due to a decrease in the activity of pancreatic enzymes and a violation of the viscosity of the secretions.
Malabsorption syndrome is caused by ailments caused by infections and parasites, abnormalities of the lymphatic and circulatory systems. SMA is also observed with damage to the small intestine and a decrease in the absorption area (the aforementioned changes that have occurred in the body cause severe disturbances in many types of metabolism, physical and mental retardation).
Thus, malabsorption is a combination of unpleasant symptoms, which can cause a huge number of different reasons. They can be combined as follows:
- Pre-enteral group. This includes diseases of the biliary tract, liver, stomach, cystic fibrosis.
- Post-enteral group. It includes disorders of lymph circulation and blood circulation in the longest section of the intestine, which is located between the stomach and colon, exudative enteropathy, lymphosarcoma, lymphogranulomatosis.
- Enteral group of reasons. This includes galactose malabsorption, celiac disease, disaccharidase deficiency, giardiasis, herpetiform dermatitis.
Symptoms characteristic of SMA
Despite the fact that malabsorption syndrome is inherent in various diseases, it is possible to distinguish signs characteristic of it. With SMA, nausea, vomiting occurs. Patients worsen appetite. Symptoms such as flatulence, a change in stool are also observed (most often diarrhea occurs). All these signs are called dyspeptic syndrome. He is a leader in the clinical manifestations of SMA.
The chair deserves special attention. Assessing the characteristics of feces, specialists receive important information that allows them to make the correct diagnosis:
- loose and foamy stools with an acidic smell - a symptom that may be inherent in such pathologies as glucose-galactose malabsorption, disaccharidase deficiency;
- fatty stools occur in chronic pancreatitis, cystic fibrosis, herpetiform dermatitis, exudative enteropathy, Pearson syndrome, intestinal dysbiosis;
- very fatty stools are observed with cystic fibrosis, congenital lipase deficiency;
- water diarrhea is a symptom that can occur when infections enter the body, enterocolitis, glucose and galactose malabsorption develop.
With SMA, pain sometimes occurs. Most often they cause intestinal infections and infestations. Pain can occur after consuming dairy products. It, in combination with frothy stools with an acidic smell, flatulence, indicates lactase deficiency. Pain in the abdomen with SMA accompanies food allergies, intestinal abnormalities, Whipple's disease, ulcerative colitis, Crohn's disease. With malabsorption syndrome, the following symptoms are still observed:
- skin rashes;
- fatigue
- feeling of weakness;
- bloating;
- anorexia.
Malabsorption in children is accompanied by deficient syndromes. Physical development is impaired. This is manifested in a decrease in body weight, the development of malnutrition, stunted growth. Vitamin deficiency is indicated by the condition of the skin. The skin becomes dry, begins to peel off. Brown spots appear on it. Hair becomes thinner and begins to fall out. Nails become dull and exfoliate. When calcium deficiency occurs, cramps, pain in muscles and bones. A lack of iron, copper and zinc leads to the appearance of a skin rash, the development of iron deficiency anemia, and an increase in body temperature.
Existing Classifications
Malabsorption syndrome combines more than 70 different diseases. In this regard, specialists encounter certain difficulties in compiling classifications. The most successful is the division into hereditary and acquired malabsorption syndromes:
- The first of them is detected in 10% of cases. Inherited SMA is passed on to the child from the parents. It is also caused by gene mutations.
- Acquired malabsorption syndrome is the result of the development of intestinal and extraintestinal diseases (for example, tumors, immunodeficiency states, liver and pancreas diseases).
There is also a classification based on the severity of malabsorption syndrome:
- I degree (mild form) - in children body weight decreases slightly, signs of multivitamin deficiency appear, disharmonious physical development is noted;
- II degree (middle form) - patients have a lack of body weight (deviation from the norm is more than 10%), there is a lag in physical development, pronounced signs of electrolyte deficiency and multivitamin deficiency are noted;
- III degree (severe form) - children are physically underdeveloped, body mass deficit exceeds 20%, in some patients there is a delay in psychomotor development.
Types of Malabsorption
In 1977, the VIII World Congress of Gastroenterologists was held. On it, experts identified several types of malabsorption, depending on the causes that cause it:
- intracavitary;
- postcellular;
- enterocellular.
Lack of bile and substances secreted by the pancreas, affecting digestive digestion and causing its disruption, is intracavitary type malabsorption. In babies, they arise due to cystic fibrosis, congenital hypoplasia of the pancreas. In older children, the appearance of intracavitary syndrome of malabsorption provokes diseases such as cirrhosis of the liver, chronic pancreatitis.
The second type of SMA is postcellular malabsorption. This is a syndrome characterized by the loss of plasma protein through the intestinal wall. It is observed with abnormalities of the circulatory and lymphatic systems. One of the diseases is idiopathic intestinal lymphangiectasia. It is characterized by a severe loss of calcium, lipids and proteins in the gastrointestinal tract.
The enterocellular type combines those cases when membrane digestion or absorption is impaired due to a defect in the enzyme systems of intestinal epithelial cells. This can be observed in young children due to hereditary diseases associated with the violation:
- suction;
- membrane digestion;
- digestion and absorption.
In older children, the enterocellular type of malabsorption syndrome occurs due to damage and death of intestinal cells due to the influence of infections or parasites, tuberculosis, tumors of the small intestine, Crohn's disease.
Examples of intracavitary malabsorption
With this type of SMA, the digestion of fats is more disturbed. Their hydrolysis is carried out by pancreatic lipase, which is activated by bile. With a lack of these substances, a symptom such as steatorrhea appears. This is a fecal discharge of excess fat. Steatorrhea is most pronounced in chronic pancreatitis. This symptom is less noticeable in diseases of the liver and biliary tract.
Among the causes of intracavitary malabsorption, it is worth considering congenital hypoplasia of the pancreas (underdevelopment). Symptoms occur from the first days or weeks of life. There is a fluid, plentiful, rapid stool with an unpleasant odor and oily sheen. Fat can even constantly leak from the anus.
Examples of postcellular malabsorption
Intestinal postcellular malabsorption occurs with exudative enteropathy. This is a syndrome in which the plasma protein is lost through the mucous membrane. The cause of exudative enteropathy may be the presence of a congenital malformation of the lymphatic vessels of the intestine. Most often, the syndrome is caused by Whipple, Crohn's disease, tumors of the small intestine, food allergy.
Exudative enteropathy sometimes occurs without obvious clinical manifestations. Symptoms such as diarrhea and steatorrhea may occur. Patients develop peripheral edema, localized on the face, lower back, perineum, limbs.
Examples of enterocellular malabsorption
The enterocellular type of SMA with malabsorption may be due to a pathology such as glucose-galactose malabsorption. This is a hereditary disease in which the active transport of galactose and glucose in the mucous membrane of the small intestine is impaired. The disease from the first days of life is manifested by diarrhea. Feces are excreted 10 to 20 times per day. They are watery, reminiscent of urine. The child's body temperature rises, vomiting occurs. With the abolition of milk, the symptoms go away. Poor tolerance of sweets and milk remains for life.
Another example of enterocellular SMA is fructose malabsorption. This is a rare genetic malabsorption. Symptoms occur after consuming fruits and juices that contain large amounts of fructose. These are apples, and oranges, and cherries, and cherries. That fructose, which is not absorbed by the body, causes flatulence, watery diarrhea, colicky pain in the abdomen. In some cases, vomiting occurs. The severity of symptoms depends on the amount of fructose ingested.
The most common cause of enterocellular malabsorption with impaired membrane digestion is disaccharidase deficiency. With it, disaccharides are not completely broken down. They are not absorbed when they enter the distal intestine and undergo bacterial fermentation with the release of hydrogen. There are attacks of intestinal colic, bloating, diarrhea, decreased appetite, regurgitation, and vomiting.
Enterocellular malabsorption of the intestine with impaired absorption and digestion can be observed with celiac disease. This is a chronic hereditary disease in which small intestine villi are damaged by certain foods. Celiac disease manifests itself in children a few months after the introduction of gluten-containing foods. With the disease:
- the frequency of bowel movements is 2 to 5 times a day;
- feces are mushy, sometimes foamy, they have a fetid odor, oily sheen;
- the stomach is enlarged;
- insufficient weight gains are observed (after some time, a growth deficit joins the mass deficit).
Diagnosis of malabsorption syndrome
Diagnosis of malabsorption is not carried out. When identifying symptoms of SMA, specialists prescribe special tests and analyzes for their patients to confirm one or another suspected pathology that provoked malabsorption or digestion.
When conducting diagnostics, doctors are guided by the following algorithm developed by the World Gastroenterological Organization:
- first, a thorough medical history is carried out, information is collected on medications taken, recent travels, the use of food and drinks that are not part of the usual diet;
- hereditary history is being studied;
- a physical examination is performed to detect signs of malabsorption;
- feces are studied, their characteristics are taken into account;
- laboratory tests are performed for more information.
Further diagnosis of malabsorption syndrome includes performing studies with suspected celiac disease, the presence of giardia, bacteria and parasites in the body. Important diagnostic information can be obtained by ultrasound examination of the internal organs of the abdominal cavity. Thanks to ultrasound, it is possible to assess the condition of the liver, pancreas, gall bladder, lymph nodes.
To exclude or confirm autoimmune gastritis, celiac disease, Crohn's disease, esophagogastroduodenoscopy with a biopsy of the stomach and duodenum is necessary. To confirm the insufficiency of exocrine pancreatic function, feces, computed and magnetic resonance imaging, retrograde cholangiopancreatography are performed to visualize ducts. To find out about the presence or absence of an ileal lesion, specialists prescribe an ileocolonoscopy with a biopsy from the study area and the colon.
Treatment for malabsorption syndrome
After diagnosing the cause of malabsorption, the doctor prescribes etiotropic treatment aimed at eliminating the identified disease. For instance:
- if celiac disease is detected, the specialist recommends the patient a lifelong gluten-free diet;
- if malabsorption of carbohydrates or food intolerance is detected, then an appropriate elimination or restrictive diet is prescribed;
- with infectious processes, antibiotic treatment is indicated;
- with metabolic and endocrine diseases, appropriate pathogenetic therapy is required.
With severe diarrhea syndrome, which causes malabsorption, treatment can be etiological, pathogenetic and symptomatic. Etiological and pathogenetic therapy can be a reception of the following means:
- antibiotics for bacterial diarrhea;
- "Metronidazole" for amoebiasis;
- anthelmintic drugs for helminthiases;
- glucocorticoids, cytostatics, Infliximab in inflammatory bowel diseases;
- "Tetracycline", "Ceftriaxone", "Co-trimoxazole" in Whipple's disease;
- "Octreotide" in endocrine tumors of the gastrointestinal tract.
Symptomatic treatment includes the use of probiotics, opiates, Loperamide, adsorbing agents (bismuth preparations, Diosmectite).
Do not self-medicate when symptoms of SMA occur. It will not give positive results. In addition, malabsorption is a manifestation of serious and dangerous diseases. If signs of SMA occur, it is recommended that you consult a doctor. Only a specialist can name the true cause of the syndrome and prescribe effective therapy to eliminate the diagnosed disease.