Malabsorption syndrome is an umbrella term used for a wide range of disorders that affect a person’s ability to absorb nutrients in their body from food. This inability to absorb nutrients can lead to indigestion and malnutrition.
There are three parts to the digestion process. The first part involves breaking down food into digestible pieces in the mouth and stomach. The second one involves absorbing all the nutrients from food in the intestines. The third part involves excreting the left-over waste. People who have malabsorption syndrome have trouble with the second stage of the digestion process and pass the unabsorbed nutrients along with the waste.
Different malabsorption disorders include food intolerances due to enzyme deficiency and gastrointestinal diseases affecting the digestive system. For example, diarrhoea causes food to move too quickly through the digestive tract for the body to absorb nutrients.
People can have general malabsorption that affects their ability to absorb all nutrients, or they can have difficulties absorbing certain kinds of nutrients.
What are the common causes of malabsorption?
People can have malabsorption for a short time period when they have the stomach flu, but if the malabsorption syndrome persists for a long time, it is usually due to an underlying condition and can be troublesome.
The small intestines are responsible for most of the nutrient absorption in the body, and a considerably small amount of nutrient absorption occurs in the large intestines.
The mucous lining of the intestinal walls secretes digestive enzymes and is responsible for absorbing nutrients in the bloodstream. But inflammation, injury, or damage to this mucous membrane can be temporary or long-lasting and affect its normal functioning. Conditions such as infectious diseases, inflammatory bowel diseases, and autoimmune conditions can damage the intestinal lining.
Listed below are some of the common causes of malabsorption:
- Chronic pancreatitis, cystic fibrosis, and other diseases that affect the normal functioning of the pancreas
- Enzyme-related conditions such as lactose intolerance
- Celiac diseases or other intestinal disorders
- Oedema (swelling with fluid) in the bowel due to severe congestive heart failure
Additionally, certain things, such as using laxatives or taking antibiotics for a long period of time, having intestinal surgery, or travelling to places that may have intestinal parasites, increase the chances of a person getting malabsorption syndrome.
Effects of malabsorption
Malabsorption can cause gastrointestinal distress due to the inability to absorb certain foods in the short term. Over time, the body starts to show signs of deficiency of the unabsorbed nutrients.
For example, people who are unable to absorb macronutrients—protein, carbohydrates, and fats—will develop muscle wasting and reduced immunity with time. People who are unable to absorb micronutrients—vitamins and minerals—may show symptoms affecting their bones, eyes, hair, and skin over time.
Different types of malabsorption tests
Listed below are some of the malabsorption lab tests that are recommended to people to assess how well they absorb nutrients from their food intake. The cost of these tests depends on the type of malabsorption test ordered by the doctor, among other factors.
Malabsorption blood tests
Different blood tests can help determine if the patient has anaemia, reduced protein levels, or insufficiencies of specific vitamins and minerals . The doctor can arrive at a likely diagnosis by using malabsorption blood tests and considering the patient’s medical history, lifestyle, and diet. Further tests may be required based on the results of these blood tests.
Malabsorption blood tests can check the absorption of protein, fat, and carbohydrates in the body, among other things.
X-ray studies
The doctor may order an abdominal X-ray to look at the internal organs and check whether the patient has enlarged and swollen (distended) loops of bowel, which may occur in people who have gas formation problems or bowel obstruction. Certain types of X-rays, such as barium meal studies and barium enemas, can be used to assess the structures and characteristics of the patient’s intestine and identify any abnormalities. This malabsorption test costs about INR 200 to INR 1300.
Stool studies
The doctor may recommend stool studies in addition to other malabsorption tests. These are done to evaluate patients who have malabsorption manifesting as diarrhoea. For a stool study, the patient is asked to eat at least 80 g of fat per day, and their stool samples are collected for 1 to 3 days. Then the malabsorption lab test is conducted to evaluate the total amount of fat in the stool samples.
The results of stool studies can reveal if a person has malabsorption syndrome. For example, bile acid deficiency and bacterial overgrowth do not result in the presence of more than 30 g of fat in the stool per day. People with celiac disease don’t produce more than 60 g of faecal fat per day. People who have pancreatic insufficiency or significant bowel resection (removal) in surgery can also produce 80–100 g of fat per day in their stool (severe steatorrhea).
Pancreatic function tests
In this test, a tube is inserted through the mouth or nose and goes all the way to the duodenum (the first part of the small intestines), close to the opening of the pancreatic duct. Then, the doctor collects secretions to examine the content of bicarbonate and enzymes in the laboratory. The patient will likely be administered a hormone called secretin or given a test meal to stimulate the pancreas. If this malabsorption lab test shows extremely low levels of bicarbonate and enzyme concentrations, it indicates pancreatic insufficiency.
Another way of detecting pancreatic insufficiency is the bentiromide test, in which the patient is given bentiromide to ingest. The chemical is broken down by pancreatic enzymes, and a component called paraaminobenzoic acid (PABA) is absorbed and excreted in the urine. Low levels of PABA in the urine indicate pancreatic insufficiency.
The cost of this malabsorption test can range anywhere from INR 800 to INR 2000.
Xylose absorption test
Doctors recommend this test to evaluate the integrity of the mucous barrier in the intestines, or intestinal mucosa, and its ability to absorb. The patient is given D-xylose, a type of sugar that is absorbed by the intestinal mucosa, and their blood and urine samples are collected for up to 5 hours.
An abnormality of the intestinal mucosa, which can cause malabsorption, is highly likely if the test results reveal low xylose levels in the blood or urine.
Hydrogen breath test
This type of malabsorption test can help diagnose specific carbohydrate intolerances in people, such as lactose intolerance. They can also be used to detect bacterial overgrowth in the small intestine.
Sweat test
This malabsorption test is specifically used for people who have cystic fibrosis, a genetic disorder that causes malabsorption among other health problems. This test measures the amount of salt in the sweat of a person in a laboratory.
Biopsy of the small intestines
In this malabsorption lab test, a small tissue sample from the insides of the small intestine is taken with the help of an endoscope. This sample is then studied in the lab to check for signs of infection or other problems.
When are malabsorption tests recommended?
If a person experiences symptoms similar to those of malabsorption syndrome, the doctor will order malabsorption lab tests. Some of the initial symptoms of malabsorption syndrome are mentioned below:
- Abdominal pain
- Bloating
- Gas or flatulence
- Abdominal distension
- Unexplained or chronic nausea and vomiting
- Frequent diarrhoea
- Steatorrhea or fatty stools
- Loose or foul-smelling stool
Other symptoms of malabsorption that appear over time include the following:
- Unintentional or unexplained weight loss
- Frequent infections (reduced immunity)
- Muscle wasting
- Skin lesions and dry skin
- Dehydration
- Oedema or swelling with fluid
- Bruising easily
- Amenorrhea or skipped periods in women
- Delayed growth in children
- Fatigue, apathy, and irritability
- Dry hair and hair loss
People who are not able to absorb specific nutrients can develop the following symptoms:
- Night blindness (indicative of vitamin A deficiency)
- Bleeding gums and nosebleeds (indicative of vitamin K deficiency)
- Red, sore tongue (indicative of vitamin B12 deficiency)
- Weak bones and pain in the bones (indicative of vitamin D deficiency)
- Weakness, dizziness, or paleness (indicative of anaemia due to vitamin deficiency)
Key takeaway
If you have been experiencing any of the symptoms caused by malabsorption that are mentioned above, it is best to consult a doctor and get yourself tested for malabsorption syndrome. Early diagnosis of malabsorption syndrome can be helpful in determining the best course of action for the patient.
Insurance providers may cover malabsorption test costs for people who have health insurance, as this is a necessary diagnostic step in the treatment of a patient. However, it is best to confirm this with the insurance provider.
