Malabsorption Syndromes

Saumil K. Shah
What are the Basic Principles of Management of Patients with Malabsorption?
Management depends on cause of malabsorption and severity of malabsorption. However, broad guidelines to be followed are:
Nutritional support:
- Anemia: Hematinic supplements (Iron, Vitamin B12, Folic Acid)
- Specific deficiencies of vitamins, minerals and trace elements - Oral supplementation (Fat soluble vitamins, calcium, magnesium, zinc, etc.)
- Temporary lactose restriction for patients with secondary lactase deficiency
- High-protein, low-fat diet
- Medium-chain triglycerides preferred as fat substitutes
- Avoid food items, which aggravate symptoms
Symptomatic treatment:
- Diarrhea: Loperamide or Diphenoxylate
- Cholestyramine (in patients with limited ileal disease)
Treatment of underlying disease: Specific therapy for underlying disease is of utmost importance.
- Celiac sprue: Avoid wheat, barley, rye and oats in diet.
- Bacterial overgrowth syndrome: Antibiotics.
- Giardiasis: Metronidazole, Tinidazole, Albendazole
- Strongyloidiasis: Thiabendazole, Albendazole, Mebendazole, Ivermectin
- Tuberculosis: Anti tuberculosis therapy
- Crohn's disease: Aminosalicylates, Corticosteroids
- Tropical sprue: Antibiotics, Folic acid
- Chronic pancreatitis: Pancreatic enzymes

Once diagnosis of malabsorption has been made, prognosis primarily depends on the cause of malabsorption. However, once the cause is found, prognosis is reasonably good in most cases, if medical and diet therapy is rigorously followed. Infectious causes if treated adequately have excellent.

It is important to remember that most causes of malabsorption, except infections require continuous supervision by a doctor and necessitate prolonged therapy.

Malabsorption Syndromes Malabsorption Syndromes 02/20/2001
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