Where food absorption may break down
Assimilation goes through three stages. First, food is broken down in the intestinal lumen by pancreatic enzymes and bile. The nutrients then pass through the lining cells of the small intestine. And finally they enter the blood and lymph. Violation at any of the stages gives a similar picture. With pancreatic insufficiency there are not enough enzymes, with celiac disease the villi are damaged, with Crohn's disease and after resections the absorption area decreases, with diseases of the liver and biliary tract there is not enough bile to absorb fats.
- Pancreatic enzyme deficiency
- Bile deficiency in diseases of the liver and biliary tract
- Damage to the small intestinal mucosa
- Reducing the suction area after surgery
- Lymphatic drainage disorder
- Bacterial overgrowth in the small intestine
Main reasons
The most common in practice are celiac disease, chronic pancreatitis with enzyme deficiency, lactase deficiency and bacterial overgrowth. This is followed by Crohn's disease, the consequences of operations on the stomach and intestines, parasitic infections, primarily giardiasis, and long-term alcohol abuse. Diseases of the intestinal lymphatic system, amyloidosis, and systemic connective tissue diseases are less common. In older people, atrophic gastritis with B12 deficiency and multiple medications contribute.
- Celiac disease
- Chronic pancreatitis and enzyme deficiency
- Crohn's disease and other inflammatory bowel diseases
- Condition after resection of the stomach and intestines
- Giardiasis and other parasitoses
- Bacterial overgrowth in the small intestine
- Chronic diseases of the liver and biliary tract
Symptoms and signs of deficiencies
On the intestinal side, concerns include copious light, greasy stools with a shine that is difficult to wash off, bloating, rumbling, and discomfort in the abdomen. General manifestations often come to the fore: weight loss with preserved appetite, weakness, fatigue. Deficiencies give characteristic clues: pallor and shortness of breath with anemia, brittle nails and hair loss with a lack of iron, numbness and tingling with a lack of B12, bone pain with a deficiency of vitamin D and calcium, swelling with a decrease in protein, bleeding gums with a lack of vitamin K.
- Copious, greasy, shiny stools
- Bloating and rumbling
- Weight loss with a normal diet
- Anemia, pallor, shortness of breath
- Numbness and tingling in the limbs
- Bone pain and muscle weakness
- Swelling and increased bleeding
Survey
The survey is built from simple to complex. Basic tests - complete blood count, albumin, iron and ferritin, vitamin B12, folic acid, vitamin D, calcium, coagulation parameters, liver tests. The coprogram detects undigested fat, and fecal elastase evaluates the functioning of the pancreas. Tests for celiac disease and stool testing for parasites are required. Endoscopy with duodenal biopsy is a key step in suspected mucosal lesions. If necessary, breathing tests, ultrasound and tomography are added.
- Complete blood count, albumin, iron, ferritin
- Vitamin B12, folic acid, vitamin D, calcium
- Coprogram and fecal elastase
- Tests for celiac disease
- Stool examination for parasites
- Endoscopy with small bowel biopsy
- Ultrasound and tomography of the abdominal organs according to indications
Treatment
Treatment is always two-component. The first is eliminating the cause: a strict gluten-free diet for celiac disease, enzyme preparations for pancreatic insufficiency, antibacterial therapy for bacterial overgrowth, antiparasitic drugs for giardiasis, anti-inflammatory therapy for Crohn's disease. The second is replenishment of deficiencies: iron supplements, vitamin B12, vitamin D and calcium, if necessary, fat-soluble vitamins and special nutritional mixtures. Meals are selected individually, often fractional and sparing. All medications and doses are prescribed by the doctor based on test results.
- Treatment of the underlying disease
- Enzyme preparations for pancreatic insufficiency
- Gluten-free diet for celiac disease
- Replenish iron, B12, vitamin D and calcium
- Small meals with sufficient protein
- Monitoring analyzes over time