Malabsorption syndromes

Staetorrhea

Clinical description

• Pale, foul smelling, greasy stools that float in the bowl and difficult to flush away

Pathophysiology

• Global malabsorption of macronutrients due to either impaired digestion or absorption

Mechanisms and clinical examples

• Decreased digestive enzymes (e.g. pancreatic insufficiency, cystic fibrosis)
• Incorrect pH environment (e.g. achlorydia)
• Decreased bile acids or enterohepatic recycling (e.g. bacterial overgrowth, ileal resection)
• Mucosal damage (e.g. coeliac disease)

Complications

• Weight loss / Failure to thrive
• Anaemia (multifactorial) e.g. Fe def, B12/folate def
• Vitamin deficiency e.g. Fat soluble - Vit D - osteoporosis, Vit K - coagulopathy
• Protein deficiency e.g. brittle hair, oedema

Screening investigations

• Directly measure undigested components e.g. faecal fat
• Measure breakdown products of undigested components e.g. H2 breath test
• Measure components of digestive juice e..g. pancreatic elastase
• Measure recovered nutrients e.g. Schilling test

Treatment

• Remove offending cause (e.g. gluten - Coeliac disease, antibiotics - bacterial overgrowth)
• Replenish digestive enzymes (e.g. pancreatic supplements - cystic fibrosis)