Malabsorption Syndromes

Saumil K. Shah
How to You Initially Investigate Patients with Malabsorption Syndrome?

Blood tests Abnormal result
Complete hemogram, 

Mean corpuscular volume
Anemia Microcytic - Iron deficiency

Macrocytic - Vitamin B12, folic acid deficiency
Peripheral smearHypersegmentation of polymorphic nuclei - Vitamin B12, folic acid deficiency. 

Howell Jolly bodies - Gluten sensitivity, Crohn's disease

Acanthocytes - Abetalipoproteinemia
ESR, C-reactive proteinTuberculosis, Crohn's disease, lymphoma, IPSID, vasculitis
Prothrombin timeVitamin K malabsorption
Serum albuminProtein loss through gut or amino acid malabsorption
Serum calciumVitamin D and calcium malabsorption
Serum phosphateVitamin D malabsorption
Serum alkaline phosphataseVitamin D malabsorption
Serum cholesterolLipid malabsorption
Serum potassium
Increase loss due to excessive diarrhea
Serum iron, serum ferritinIron deficiency
Serum folate, red cell folateFolic acid deficiency
Serum zincZinc deficiency
Serum magnesiumMagnesium deficiency
Serum vitamin B12Vitamin B12 deficiency
Stool - Routine / MicroscopySteatorrhoea, Giardia lamblia, Neutrophils in inflammatory disease
X Ray Abdomen *Calcification (Chronic pancreatitis)
HIV (ELISA) *Human immunodeficiency virus
Thyroid function tests *Hyperthyroidism
Immunoglobulin A *Low immunoglobulin levels
Specific antibodies *Antigliadin (IgA) / Antiendomysial (IgA) - Gluten sensitivity
Sweat chloride *Cystic fibrosis

* Only if clinically suspected

Schilling testTo evaluate cause of vitamin B12 deficiency
Fecal fat estimationChronic pancreatitis, Small intestinal mucosa disease
Xylose tolerance testSmall intestinal mucosa disease
Small intestinal barium studySmall intestinal mucosa disease
Endoscopy with small intestinal biopsy
Small intestinal mucosa disease
US abdomen, CT scan abdomenChronic pancreatitis, Tuberculosis
ERCPChronic pancreatitis
Tests to evaluate pancreatic exocrine function (Tube and tubeless tests)Chronic pancreatitis
Breath testsBacterial overgrowth syndrome, Lactase deficiency

Malabsorption Syndromes Malabsorption Syndromes 02/20/2001
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