Injection method in anatomy. Lecture

Malabsorption, what is it?

Malabsorption is the process of development of a chronic disorder in the intestines, manifested in impaired digestion of food, failure of absorption, and transport of nutrients to the small intestine. Among the main symptoms of this disease are diarrhea, abdominal pain, lack of vitamins in the body, as well as a feeling of general weakness. The disease is diagnosed by conducting laboratory tests, including a biochemical blood test, x-ray of the large intestine, and ultrasound abdominal cavity. Treatment involves eliminating the symptoms of the disease, identifying the causes of malabsorption, and correcting various types of deficiencies, in particular protein, electrolyte, vitamin and microelement deficiencies. In addition, when treating diseases, signs of intestinal dysbiosis are diagnosed and eliminated.

The symptoms of the disease are caused by the main functions of the small intestine, in particular transport and absorption. The result is the development of pathological changes in metabolism. The congenital type of syndrome, according to statistics, is diagnosed in approximately 10% of the total cases. This usually appears in the first 10 years of a person’s life. Acquired malabsorption correlates with the overall prevalence of pancreatitis, enterogenous and gastrogenic diseases.

Glucose-galactose malabsorption syndrome

Glucose-galactose malabsorption syndrome is a disease manifested in disruption of the absorption of simple carbohydrates within the intestine. This condition is caused by a disruption of the transport system of the brush border of red blood cells.

The result of the development of this condition is the formation of metabolites of simple sugars, which are gradually deposited in the liver, kidneys, and lens and cause malfunctions of these organs and body systems. Cells of the nervous system find themselves in conditions oxygen starvation due to demotion general level glucose in the body, which can result in disruption of growth processes and general development. The disease can be congenital or acquired. In the first case, it manifests itself when feeding the child, in the second, the cause is a disruption in the functioning of the digestive tract.

This type of malabsorption most often appears soon after the child is born. The main symptom of the disease is the child's loose stool, accompanied by a sour odor. The child's sleep is disturbed, and his stomach often begins to hurt.

Children with this diagnosis cry a lot and sleep very poorly. However, over time, they develop pathological drowsiness. Appetite gradually decreases. Jaundice may appear with further development of the pathological process. The child begins to suffer from flatulence and suffers from colic. This type of disease gradually leads to an increase in liver size.

Chronic malabsorption syndrome

Chronic malabsorption syndrome is a disorder of the absorption process in the intestine. There is a whole complex of symptoms of this disease that arise due to impaired absorption through the intestinal mucosa of one nutrient or a whole complex of them.

Chronic malabsorption syndrome can also be congenital and acquired. Symptoms and general signs diseases are different every time. The hereditary form of the disease is characterized by disaccharidase deficiency, as well as intolerance to gliadin by the body. Very often, an acquired form of chronic malabsorption accompanies many forms of chronic diseases of the intestines and stomach, in particular hepatitis, pancreatitis, as well as infections in the intestines and Crohn's disease.

The clinical picture of this disease is characterized by severe diarrhea, in which the stool contains a large number of lipids. In the case of children, dystrophy gradually develops; children noticeably lose weight and lag behind in development. In addition, there is a gradual development of vitamin deficiency, the water-electrolytic balance is disturbed, the skin becomes dry, jams and growths appear on it, and edema may appear due to the development of vitamin deficiency. Very often, chronic malabsorption syndrome manifests itself already in the first months of a child’s life, depending on the cause that caused this disease.

This diagnosis is often made if the patient has had loose stools with a high concentration of fat in the stool for a long time. This condition is very difficult to treat.

Fructose malabsorption

Fructose malabsorption is a rare type of malabsorption in the body, manifested in a failure in the processes of glucose synthesis from fructose and its subsequent transportation. The main glucose transport channels are not disrupted.

The clinical picture of this disease becomes obvious after consuming juices and fruits that contain fructose. large quantities. This applies to oranges, apples, cherries, and also cherries. It is the amount of fructose that enters the body after eating these fruits that determines the severity of the disease. Fructose tends to cause diarrhea, flatulence, and in some cases vomiting and intestinal colic.

When consuming juices that do not contain a sufficient mixture of lactose and glucose, none of the described symptoms occur.

If this condition manifests itself from birth, this indicates poor tolerance of juices and fruits. It is useful to keep a food diary; this will help determine the time of occurrence and development of pathological manifestations and their nature. Any suspicion of fructose malabsorption requires the preparation of a sugar curve and a hydrogen test with fructose. In this case, the diagnosis is confirmed when the curve looks flat and the hydrogen concentration increases immediately after eating.

Clinical symptoms are eliminated after stopping eating fruits, as well as removing from the diet all juices characterized by a high fructose content. This applies to apples, oranges, peaches, cherries and pears, as well as juices from all these fruits.

Lactose malabsorption

Lactose malabsorption or lactase deficiency is a disorder in the breakdown of lactose resulting from lactose deficiency in the mucous membranes of the small intestine, which is accompanied by the appearance of clinical symptoms.

Lactose is a polysaccharide that is made up of parts of glucose and sucrose molecules. The brush border enzyme lactase causes the breakdown of lactose in the small intestine.

Lactic sugar intolerance is quite common, as a result of which it cannot in all cases be considered a disease and begin to be treated. Many people simply do not tolerate lactose due to the properties of their body, but do not feel any discomfort and freely eat it with the main meal, without even suspecting its presence in it. Such people also do not assume about their own enzymatic characteristics. The problem of enzyme deficiency is especially relevant in the case of children younger age, since milk is their staple food.

As in the previous described cases, congenital lactose malabsorption and an acquired version of this disease are distinguished. According to the degree of manifestation of malabsorption, the type of disease can be primary or secondary.

Lactose malabsorption is the most common defect of the enzyme system of the mucous membranes of the small intestine. In the adult population of the Earth, the primary form of this syndrome occurs in approximately half of the cases of diagnosis of this disease. The prevalence of lactose malabsorption is determined by the geographic location of the patient. The most common spread of this form of the disease is in northern latitudes. The race of the patient also plays a role.

Classification

A classification of malabsorption syndrome has been established according to the severity of the disease and the factors causing its appearance. It can become more complicated due to the fact that malabsorption syndrome can also be accompanied by poor digestion syndrome. Today, the concept under consideration combines about 70 different pathologies that affect the digestive system.

By severity

Depending on the severity of the disease, the following stages of the disease are distinguished:

First degree of disease severity. It is considered to be the mildest, at this stage there is a decrease in the patient’s weight, a decrease in the overall level of his performance, an increased feeling of weakness and the appearance of signs of general vitamin deficiency. The patient may lose up to 10 kilograms in weight.
Second degree of severity of the disease. In this case, there is a noticeable decrease in the weight of the entire body; in approximately half of all cases that occurred, the patient’s body weight decreased by more than 10 kilograms. At the same time, symptoms of vitamin deficiency were clearly manifested, and calcium deficiency was noted in the body. The body also lacks potassium, anemia develops, and the activity of the sex glands decreases.
Third degree of severity. In the vast majority of cases, at this stage of the disease, the body weight of patients decreases by more than 10-15 kilograms. In addition, the condition is often accompanied by pronounced symptoms of multivitamin deficiency, lack of electrolytes in the body, seizures and pronounced signs of osteoporosis. In addition, anemia gradually develops, patients often begin to complain of general weakness, malaise, and they develop swelling in the different zones body and the functioning of the endocrine gland is disrupted.

Treatment in each case is selected depending on the specific severity of the disease and its symptoms.

By nature of origin

By nature, the origin of the disease, malabsorption, can be congenital or acquired. In the first case, malabsorption is observed in only one tenth of all cases of the disease. In most cases, this applies to people who have previously suffered from: celiac enteropathy, lactase deficiency, various types of cystic fibrosis, congestive deficiency, Hartnup disease, as well as cystinuria in its various manifestations.

A type of malabsorption acquired throughout life is mainly a consequence of the following diseases suffered by humans: enteritis in various varieties, idiopathic hypoproteemia, cancers in the small intestine, cirrhosis of the liver. In some cases, an acquired type of malabsorption is observed in people suffering from intolerance to the protein contained in cow's milk.

Symptoms of malabsorption

Malabsorption syndrome has pronounced symptoms, which even at their first manifestation every doctor will notice. This greatly facilitates making an accurate diagnosis at the onset of the disease. Among the most striking symptoms of this syndrome, doctors identify the following:

Loose stools, diarrhea. Stools become significantly more frequent; they can be repeated up to 15 times a day. The feces become mush-like, acquire an unpleasant odor and have dark color. Sometimes it can be watery.
Fatty stools (steatorrhea). An oily tint begins to predominate in the stool, and an easily visible shiny coating appears. Patients have noticed that it can be quite difficult to wash such feces from the walls of the toilet. In some cases, the discharge of such feces continues even after taking special medications.
Cutting and pain in the abdominal area. Basically, such symptoms appear immediately after eating, in almost all cases they are accompanied by a loud rumbling, which does not stop even after use. medicines antispasmodic and analgesic effect. The pain also does not always stop after using such drugs.
Muscle weakness due to a constant feeling of thirst. Similar symptoms are typical for prolonged diarrhea; such symptoms appear due to large losses of fluid by the body, which leads to similar manifestations.
Change in appearance sick. A person's nails become more brittle and become very fragile. Nails peel, skin becomes dull and gray, and a person’s hair falls out.
Weight decreases. A person loses a lot of weight without any external motivating factors. At the same time, his adequate nutrition does not stop, while maintaining a hypodynamic lifestyle.
General fatigue increases. Performance decreases, a person becomes drowsy due to insomnia at night, and he develops a general feeling of weakness throughout the body.
Bone fragility increases. Such symptoms are typical against the background of a general lack of vitamins. The body lacks additional vitamins and microelements.
The body begins to tolerate milk and dairy products poorly. Previously, this may not have been observed, however, with the subsequent development of malabsorption syndrome, eating dairy-based products causes increased gas formation, as well as pain in the abdominal area, which comes with contractions.
Iron deficiency anemia. There is a decrease in the overall level of hemoglobin in the blood, resulting in a general feeling of weakness and increased fatigue. The reason lies in the disruption of the process of iron entering the human body.

Symptoms can occur individually or in combination of several at the same time. Depending on the nature of the symptoms, the desired type of treatment for the disease being described is selected.

Causes

Malabsorption syndrome is caused by a whole range of reasons. Among the most common are the following:

The effect of acute intestinal infections after illnesses suffered by the patient.
Poor mixing of the substances in the stomach or the patient's stomach emptying too quickly.
a lack of necessary for the body digestive elements.
Availability external factors, which have a depressing effect on intestinal motility. This most often occurs when intestinal motility is impaired due to diabetes mellitus.
Serious damage to the epithelial tissue of the stomach.
Damage to the gastric epithelium that has become chronic.
Disorders of intestinal transport function.

Among the main causes of malabsorption syndrome are various lesions: infectious, toxic, radiation, and allergic. There are also processes of infiltration and decreased absorption in the small intestine. The absorption of nutrients changes as a result of disruption of their digestion. In addition, with their prolonged and poor absorption, the development of chronic diarrhea and protein deficiency is noted.

Diagnosis of malabsorption syndrome

When diagnosing malabsorption, laboratory analysis of the patient’s urine and stool is used as the main research method. Tests of his blood are also being carried out. Carrying out general analysis blood can help determine the presence of signs of anemia, iron deficiency and characterized by a lack of vitamin B in the body. In addition, Negative influence the development of the disease is influenced by a lack of vitamin K in the body. biochemical analysis blood test helps detect the presence of calcium and alkaline phosphatase in the blood. In addition, this analysis helps determine the level of albumin in the patient's blood.

Stool analysis is necessary for precise definition daily increase in its volume. If the patient is starving, it is necessary to accurately determine the amount of stool reduction. The presence of starch and muscle fibers in the feces is detected. In some cases, with enzyme deficiency, the pH of the stool may change. A test for steatorrhea is carried out in cases where it is necessary to determine the degree of disruption of the absorption of fatty acids into the body.

An X-ray examination helps determine the degree of disease of the small intestine, as well as the condition of the loops of the small intestine, the presence of blind loops in them, their general state. In some cases, horizontal levels of gas and liquid can be found in the blind loops of the small intestine, as well as various disorders normal condition small intestine.

Additional diagnostic measures assess the condition of the pancreas and the level of its secretion. In addition, bacterial overgrowth syndrome is determined, as well as lactase deficiency.

Complications

The main complications of malabsorption syndrome are associated with disturbances in the supply of nutrients to the patient’s body and, as a consequence, their lack in the body. The lack of nutrients in the patient's blood, as a result of disruption of their entry into the blood, causes anemia, which can be iron deficiency and vitamin-dependent. In addition, complications of malsorption include fertility disorders, dystrophy, various neurovegetative disorders, as well as internal pathologies of organ development associated with a lack of vitamins and beneficial microelements in the body.

Malabsorption syndrome: treatment

To ensure high-quality elimination of malabsorption syndrome, the treatment used must be comprehensive. This should include the use of medications, dietary requirements, and general patient management. healthy image life. In addition, the effectiveness is shown by the use of funds traditional medicine.

There are the following clinical recommendations for the treatment of malabsorption syndrome:
1. An ultrasound study allows you to determine the level of condition of the gallbladder, bile excretion pathways, the condition of the kidneys and pancreas, as well as the intestines to determine the degree of damage to these organs and prescribe the correct course of treatment.

2. Conducting an X-ray examination of the condition of the skeletal bones allows us to identify disturbances in the supply of beneficial vitamins and minerals to the bones, as well as determine the elements that are necessary to strengthen bone tissue.

3. A colonoscopy helps determine exact condition colon, and also prescribe measures to improve the condition of the epithelium of the intestinal mucosa. Condition is being assessed inner surface colon, with a special optical instrument. In this case, a biopsy is required to conduct research and establish the diagnosis.

4. A more detailed determination of the condition of internal organs is facilitated by computer diagnostics. At the same time, the condition of the stomach is assessed, duodenum, as well as identifying tumors whose condition is difficult to diagnose and damage to the intestines.

Drugs

Drugs for the treatment of malabsorption should be prescribed for use only by an experienced doctor; unauthorized treatment of the disease is unacceptable. A medical examination must first be carried out and appropriate medications prescribed for use. First of all, it is necessary to completely eliminate the cause of such a disease in order to completely get rid of it. Treatment with drugs involves the prescription of antibacterial agents, as well as enzymatic drugs and medications that help dilute bile and its subsequent removal from the body.

In this case, one should take into account the fact that when undergoing medication treatment, any physical activity is contraindicated for the patient. It is recommended to do walking and simple exercises as part of morning exercises. The patient should not remain completely immobile.

Folk remedies

Malabsorption can be treated in various ways. folk remedies. In the event that the symptoms of the disease have just begun to develop, and no serious disorders have yet been noted, you can use a simple anise-based remedy. A tablespoon of dried anise seeds is poured into a glass of warm milk and stirred in it. After this, the milk is brought to a boil and immediately removed from the heat, after which it is drained. You should drink a glass of this milk twice a day. If you are lactose intolerant, you can use water instead of milk. This remedy helps improve the functioning of the digestive tract, eliminates unnecessary gases from the intestines, eliminates diarrhea and nausea.

To improve the functioning of the digestive system after meals, it is recommended to eat spices such as cumin, dill, fennel or cardamom. This increases the secretion of enzymes produced by these plants and generally improves the absorption of nutrients in the body.

In addition, it is recommended to take persimmon and papaya for dessert after eating the main meal. In such cases, digestion improves, diarrhea and abdominal pain are eliminated. In addition, instead of tea, you can prepare compotes to improve the functioning of the digestive system.

Diet

The patient's diet must be adjusted when treating malabsorption syndrome. Be sure to follow these diet instructions:

In no case should you eat sweet pastries, as well as fatty fish, spicy seasonings and sauces. It is prohibited to eat mayonnaise, fatty meats, spinach and sorrel, various types of coffee, all kinds of canned food, semi-finished products and fried meat.
It is allowed to gradually introduce compote, as well as jelly from fruits and berries, into the diet. Low-fat cottage cheese, slightly dried wheat bread, and fresh juices are good for helping the body recover after illness. It is recommended that the patient eat weak tea, as well as lean rabbit meat, beef and chicken.
You should eat frequently and in small portions. It is recommended to eat at least 6 times a day. The breaks between meals should be at least two hours, the maximum serving size is no more than a quarter of a kilogram.
The intake of vitamins into the body should be maximized. Be sure to eat foods that contain folic acid and vitamins of the main groups B and C in sufficient quantities.

Preventive measures

Preventive measures aimed at preventing the occurrence of malabsorption in the patient include a set of measures:

timely diagnosis and treatment of diseases that cause the occurrence and development of malabsorption;
diagnosis and timely treatment of diseases that cause hereditary diseases, in particular this applies to the diseases cystic fibrosis, celiac disease, associated with the course of the process of breakdown of enzymes during digestion;
consumption of a complex of vitamins and minerals;
taking enzyme medications that improve digestion and also minimize the symptoms of malabsorption.

The small intestine performs many important functions: the processes of secretion, movement of the remains of consumed food, partial digestion and absorption take place in it. useful substances. It is in this part of the intestine that the body can obtain fat-soluble vitamins from food. Violation or complete shutdown of these functions is very dangerous for the body, this problem called malabsorption syndrome.

What is malabsorption syndrome

Malabsorption syndrome often manifests as chronic diarrhea

Malabsorption syndrome is a disruption of normal absorption processes in the small intestine, which affects both adults and children. Depending on the complexity of the disease, disturbances in the absorption process of one or several food components (proteins, fats, carbohydrates, vitamins, minerals) may be observed. When it comes to childhood, the most common diagnoses are lactose, fructose or gluten intolerance (celiac disease).

Specialist's note: it is worth mentioning such a type of problem as the glucose-galactose form of the syndrome (impaired absorption of both glucose and galactose). This disease is genetic in nature and is quite rare. The problem is a mutation of the gene responsible for the synthesis of transport protein, which is why children develop tissue breathing disorders, mental and mental health problems. physical development– red blood cells lose their ability to transport oxygen.

Video about a type of disease - celiac disease

Classification

The classification of the syndrome is quite complicated, since today this term combines more than 6 dozen types of malabsorption. There are several options for the development of the situation: only one substance is not absorbed (selective type of malabsorption), a whole group of substances is not absorbed, as well as a total form of the disease, when the intestines are seriously affected and not a single substance is absorbed normally . Classification according to the type of substance not taken implies the division of the syndrome into the following groups:

carbohydrate malabsorption;
impaired protein absorption;
inability to absorb fats;
inability to absorb vitamins;
impaired absorption of minerals;
disaccharide and monosaccharide deficiency;
amino acid deficiency.

The most general division of the syndrome is based on the reasons for the formation of disorders; according to this classification, malabsorption can be divided into congenital and acquired.

Congenital

The congenital or hereditary form is diagnosed in every tenth patient with this diagnosis. Often, patients with this problem are children who developed pathologies even at the stage of development inside the womb. Most common the following options syndrome: celiac disease, disaccharide deficiency, lactase deficiency, amino acid transport disorder, Hartnup disease, etc.

Acquired

The acquired syndrome is associated with other diseases that the patient has and provoke dysfunction of the small intestine. Most often, this problem is diagnosed in patients with Whipple's disease (a rare infectious disease associated with blockage of the lymphatic vessels in the area small intestine), enteritis, short bowel syndrome, malignant neoplasms in the intestines, cirrhosis of the liver.

Causes

There are a lot of reasons for the development of malabsorption syndrome; we can identify both specific conditions that contribute to the development of disorders in the small intestine, and a huge number of diseases that create these conditions:

Manifestations of the syndrome can be as follows: general character, and be variable, depending on the specific type of disease. The main signs of a problem include:

painful sensations in the abdomen, frequent rumbling;
diarrhea (increased volume of stool, foul odor, watery consistency);
weight loss;
changes in the condition of the skin.

Possible specific symptoms:

changes in the skin, tongue and mucous membranes due to vitamin deficiency;
the skin begins to peel off, pigment spots may form;
nails peel, hair becomes thinner and falls out intensively;
pain in bones and muscles, blurred vision in the dark may occur;
swelling, especially in the area of the feet and legs;
convulsions;
muscle weakness;
dysfunction of the reproductive glands, decreased libido, menstrual irregularities or impotence.

Based on symptomatic manifestations, it is possible to determine which substance the body lacks due to a violation of its absorption.

Diagnostics

Of great importance in the first stages of examining the patient is a complete and detailed collection of anamnesis; very often it is scrupulousness in this procedure that helps not only to suspect malabsorption syndrome, but also to identify its cause. early stages. It is also necessary to undergo a number of laboratory and hardware tests, which include:

functional tests (for example, Schilling test);
blood and stool tests;
X-ray of the intestine with a contrast agent;
ultrasound and magnetic resonance imaging;
endoscopy with collection of biological material.

As part of differential diagnosis, specialists are faced with the task of separating the problem from other diseases. Intestinal failure can be associated with three processes, one of which is malabsorption, and the other two are:

maldigestion (impaired digestion of nutrients in the intestinal lumen or its mucous brush border);
malassimilation is a situation in which both syndromes occur, that is, the processes of food digestion and absorption of substances are disrupted.

Disease severity

For the most accurate description To determine the patient's condition, doctors use division of the complexity of the syndrome into three stages of severity.

Treatment

Treatment activities take place in several stages. The first thing that needs to be done is to eliminate the existing symptoms of the syndrome, then doctors work on bringing body weight back to normal, after which the root cause disease is identified, and all efforts are rushed to eliminate it. Only after neutralizing the cause are treatment for complications of the syndrome and preventive measures prescribed. Traditional methods in this situation are ineffective.

Conservative

The main methods of conservative treatment of malabsorption syndrome include taking medications and prescribing a special diet. As part of the drug method, the following drugs are usually prescribed (they vary depending on the specific type of syndrome):

vitamin therapy (additionally, vitamins that are not absorbed in the intestine are introduced to eliminate deficiency);
taking an antibiotic (this could be tetracycline, doxycycline, streptomycin, amoxicillin, gentamicin, etc.);
prednisolone as an element of hormonal therapy;
drugs against diarrhea and to reduce the secretion function of the small intestine;
pancreatic or choleretic agents;
antacid therapy to reduce the likelihood of the formation of ulcerative lesions.

Diet

Patients with malabsorption syndrome are required to adhere to certain rules nutrition. So, their diet should be characterized high content protein, and the fatty component is reduced.

Sample menu for the day for severe malabsorption syndrome.

Expert opinion: in some cases, doctors may resort to prescribing enteral nutrition - direct administration of mixtures containing all the necessary elements through a tube directly into the stomach.

Surgical

The need for surgical intervention occurs only in isolated cases and is due to the specifics of the disease, which provokes malabsorption syndrome in the small intestine. Indications for surgery are:

Crohn's disease;
blockage of secondary lymphatic vessels;
cirrhosis of the liver;
liver failure.

Possible complications

Given the variety of options for the development of the disease, possible consequences and complications can be very diverse. The most likely consequences are:

reproductive dysfunction;
anemia;
formation of malignant tumors;
arterial hypotension;
narrowing of the intestinal lumen;
ulcerative lesions and intestinal perforation.

Features of the disease in children

In children, the disease is usually congenital and does not appear immediately, but in connection with certain events:

introducing cereal products into the diet (for celiac disease);
in case of protein intolerance and lactose deficiency, the syndrome “starts” at the first consumption by the child cow's milk or milk formulas;
Glucose deficiency is activated by supplementing the children's diet with foods containing sugar;
malabsorption syndrome may be caused food allergies, which arose in children's body in response to the introduction of a particular product, etc.

Proper feeding is of great importance in ensuring normal development for an infant. As you know, optimal nutrition is breast milk, but sometimes you have to use formula. It is important that they are selected correctly, for example, children with celiac disease simply need gluten-free formulations, for example, Nutrilon Malabsorption. For older children, an important aspect of treatment is the introduction of lactic acid preparations with dietary supplements into the diet.

Malabsorption syndrome is a complex and multifaceted problem; disruption of the normal absorption of substances from food can be due to various reasons. In the treatment of a disease, the primary task is to identify and eliminate the provoking factor, then the results of therapy will be as positive as possible.

Malabsorption in the intestine is medically called malabsorption syndrome. This disease occurs due to changes in the digestive and transport function of the small intestine, which provoke metabolic disorders. The disease is characterized by a number of clinical manifestations, such as weight loss, diarrhea, multivitamin deficiency, etc. Malabsorption can be congenital or acquired as a result of various diseases gastrointestinal tract(liver cirrhosis, short bowel syndrome, chronic pancreatitis and others).

Malabsorption syndrome, symptoms

Malabsorption has quite specific symptoms that can be used to determine the presence of this disease in a person. The most common among them are:

Diarrhea;
Steatorrhea;
Asthenovegetative syndrome;
Various disorders due to vitamin deficiency.

In patients suffering from malabsorption, there are disturbances in the functioning of the intestines, bloating, rumbling and painful sensations in the abdominal area. Pain is usually observed in the upper part and can radiate to the lower back. The amount of feces with this disease increases noticeably, and it acquires a watery consistency, and sometimes an oily sheen. This phenomenon is called steatorrhea.

The manifestation of asthenovegetative syndrome with malabsorption is characterized by disturbances in the nervous system of a sick person. Fatigue, a state of apathy and general weakness of the body are the main signs of the syndrome, caused by a lack of substances necessary for the proper functioning of the nervous system.

Malabsorption syndrome is also manifested by pathological processes of the skin, which are provoked by a lack of vitamins and substances. Thus, such disorders can lead to eczema, dryness and age spots on the skin, dermatitis and hair loss, brittleness and darkening of nails. In addition, a lack of a specific vitamin or substance can cause a separate problem:

A lack of vitamin K often leads to subcutaneous hemorrhages and the appearance of red dots on the surface of the skin;
A lack of vitamin E negatively affects the nervous system, causing various neuropathies;
Vitamin A deficiency provokes twilight vision disorder;
A lack of vitamin D contributes to the development of muscle pain and osteoporosis;
Reduced protein content in patients leads to accumulation of fluid in the abdominal cavity;
Zinc and copper deficiency causes skin rashes.

Also, one of the most important symptoms of malabsorption can be called rapid weight loss. In addition, patients sometimes experience impaired sexual function, since this syndrome leads to decreased sexual desire and even impotence. Women with malabsorption syndrome often experience menstrual irregularities, as well as the occurrence of amenorrhea.

Galactose malabsorption

Speaking about such a pathology as malabsorption syndrome, it is necessary to separately highlight its type, called glucose-galactose malabsorption. This is a rare genetic disease that is inherited and is characterized by a violation of the absorption of monosaccharides in the gastrointestinal tract. The development of the disease is caused by a mutation in the structure of the gene that is responsible for the synthesis of the transport protein. It is he who moves glucose and galactose through the walls of the small intestine.

Glucose-galactose malabsorption in children leads to impaired tissue respiration, and therefore there is a delay in physical and mental development. This is due to the fact that red blood cells lose their ability to carry oxygen and the concentration of glucose in the child’s blood decreases, and galactose metabolites gradually accumulate.

Their concentration in the heart, brain, kidneys, and lens of the eye leads to damage to these organs. Malabsorption in children can provoke cirrhosis of the liver if the metabolite accumulates in this body or in the brain.

Galactose malabsorption can also be manifested by the accumulation of metabolites in the intestinal folds and in the kidneys, which prevents the entry of amino acids into the bloodstream. When the mucous membrane of the small intestine is irritated by monosaccharides, the amount of fluid in it increases, therefore, the process of absorption of nutrients becomes more difficult. All these phenomena lead to the development of such a characteristic symptom of galactose malabsorption as diarrhea.

Treatment of malabsorption

Treatment of malabsorption involves, first of all, eliminating the disease that caused the syndrome and the accompanying dysbacteriosis. In addition, it is aimed at correcting the diet through diets, as well as eliminating electrolyte disturbances and motor changes in the digestive system, correcting pathologies of protein metabolism and vitamin deficiency.

Thus, treatment for malabsorption can be divided into three main types:

Diet therapy;
Drug treatment method;
Surgical method.

Diet therapy for malabsorption primarily involves eating foods high in protein. Fats in the diet of a sick person, especially if there is a symptom of the disease such as steatorrhea, should be reduced by almost half. Often, to treat malabsorption, doctors recommend the use of various special mixtures, vitamins and microelements.

The medicinal method of treating the disease, in turn, includes:

Medicines that correct vitamin and mineral deficiencies;
Antibacterial drugs;
Antacid therapy;
Hormonal therapy;
Medicines with choleretic effects;
Antidiarrheal and antisecretory drugs;
Pancreatic enzymes.

Surgical intervention for malabsorption is required in especially severe cases and is aimed at eliminating the disease that provoked the development of this syndrome in the patient.

Video from YouTube on the topic of the article:

The human body is a universal and complex mechanism, the components of which are interconnected. Sometimes failures occur that affect all systems. An example of this is malabsorption syndrome, a condition characterized by impaired absorption of certain elements. What to do to correct the situation?

What is malabsorption syndrome: glucose-galactose form

Malabsorption (chronic diarrhea syndrome) is a condition in which malabsorption of nutrients occurs. The disease occurs in adults and children, and for the child’s body, which is just being formed, the disorder causes more harm - the pathology negatively affects physical and mental development.

The glucose-galactose form of malabsorption has a hereditary predisposition. The pathology is characterized by a change in the gene responsible for the formation of the transport protein. This component takes part in the movement of galactose and glucose, so the disease often occurs against the background of diabetes mellitus. As a result of the violation:

the concentration of glucose in the blood decreases;
oxygen transport by red blood cells deteriorates;
symptoms of mental and mental disorders are formed.

Features of the condition in young children

The manifestation of the syndrome is influenced by the following factors:

allergy to a certain product;
foods with sugar - can trigger glucose deficiency;
infant formula and cow's milk - for lactase deficiency and protein intolerance;
cereal food - for celiac disease (damage to the villi of the small intestine due to exposure to certain foods with proteins).

Statistics: the congenital form of malabsorption is most often detected immediately after birth or in the first 10 years of a child’s life. Survival depends on the type of pathology that caused the syndrome.

Video about one of the causes of malabsorption - celiac disease

Classification of violations - table

Disease (cause of disorder)	Indigestible substance
Primary malabsorption: glucose and galactose; fructose.	glucose and galactose; fructose.
Hartnup disease	neutral amino acids
Cystinuria	cystine and essential amino acids
Congenital lysuuria	lysine and other essential amino acids
Primary tryptophan malabsorption	tryptophan
Iminoglycinuria	glycine, proline, hydroxyproline
Lowe's syndrome	amino acids
Primary methionine malabsorption	methionine
Abetalipoproteinemia	lipids
Primary malabsorption of bile acids	bile acids
Primary malabsorption of vitamin B12	vitamin B12
Primary malabsorption of folic acid	folic acid
Acrodermatitis enteropathica	zinc
Primary hypomagnesemia	magnesium
Menkes syndrome	copper
Familial hypophosphatemic rickets	phosphorus
Congenital chloridorrhea	electrolytes
Lethal familial persistent diarrhea	electrolytes

Causes: lactase deficiency, intestinal diseases, diabetes mellitus and others

Malabsorption syndrome is a multifaceted and complex process. IN human body There are many enzymes and nutrients, and disruption of the absorption of one of them causes negative changes. The following reasons can lead to the formation of a congenital type of disorder:

lactase deficiency;
celiac disease;
Hartnup's disease;
disaccharide deficiency;
disruption of amino acid transport.

The acquired form is associated with exposure to a specific disease or intervention:

Symptoms of the syndrome

The main signs of malabsorption syndrome include:

frequent stomach rumbling;
diarrhea;
weight reduction;
discomfort in the abdominal area;
change in skin condition.

Specific signs are also characteristic of the pathology:

peeling of the skin;
changes in mucous membranes, tongue and skin;
convulsions;
intense hair loss;
pain in muscles and bones;
weakness;
swelling;
blurred vision in the dark;
changes in the sexual sphere: disruption of the menstrual cycle, decreased libido and impotence.

Symptoms of impaired absorption of substances - table

Type of violation	Manifestations
Impaired fat absorption	the chair has light color, unpleasant odor and large volume, it is soft in consistency
Protein malabsorption	swelling; changes in hair strength and hair loss.
Impaired absorption of carbohydrates	bloating; flatulence; diarrhea.
Violation of vitamin absorption	anemia; decreased blood pressure; weight loss; night blindness (vitamin A deficiency); increased bleeding (vitamin K deficiency).
Impaired absorption of minerals and trace elements	muscle pain; weakness; lethargy; skin rash; anemia; elevated temperature.

Severity

Depending on the severity, the disease can have a mild, moderate or severe course.

Signs of malabsorption depending on the degree - table

Establishing diagnosis

Such a complex disorder requires a complete diagnosis of the patient, so several examination methods are used:

Blood test:
- biochemical analysis - low levels of protein and calcium are detected;
- general analysis - anemia is detected;
- identifying the level of coagulation - helps to detect vitamin K deficiency;
- determination of the content of substances in the blood: sodium, calcium, electrolytes, vitamin B12 and iron.
Additional research:
- stool analysis - unabsorbed elements are detected in the patient’s stool, the level of fatty acids is increased;
- determination of autoantibodies - necessary for the development of celiac disease;
- Diagnosis of the secretory function of the pancreas.
Test samples:
- breath test with xylose - detects the growth of pathogenic microflora;
- Schilling test - assess the degree of malabsorption of vitamin B12;
- pancreolauryl and stimulated secretin test - study pancreatic insufficiency;

To confirm pathology and differential diagnosis, instrumental research methods are used:

biopsy of the intestinal mucosa - reveals the disease or tumor that caused the disorder;
magnetic resonance and computed tomography;
endoscopy of the duodenum and colon, as well as the stomach and esophagus - detect diseases and other causes of the syndrome;
ultrasound examination of the abdominal cavity;
X-ray diagnostics - detect anatomical changes indicating bacterial growth.

Differential diagnosis: maldigestion, malassimilation - table

Treatment methods

The goal of therapy is to eliminate the signs of the disorder, but this is impossible without eliminating the cause of malabsorption. Treatment is carried out in several stages:

elimination of symptoms;
weight normalization;
identifying the cause and eliminating it;
neutralization of consequences;
adherence to the regimen to prevent relapse.

Note! Traditional medicine is ineffective for the treatment of malabsorption syndrome, so they are not used.

Drug treatment method

Purpose medicines- one of the methods of treating malabsorption. Depending on the type of disorder, the following may be prescribed:

vitamins and minerals (Folacin, Nicotinamide, Sufer, Ferrum Lek) - elements that are not absorbed by the body are used;
antibiotics (Gentamicin, Amoxicillin, Novosef, Doxycycline, Bactrim) - used for infectious lesions;
hormonal therapy (Prednisolone) - prescribed for Crohn's disease, celiac disease and other inflammatory processes;
pancreatic drugs (Mezim, Pangrol, Creon) - compensate for the lack of pancreatic enzymes;
choleretic agents (Allohol, Nikodin, Ursofalk) - increase the secretion of bile;
probiotics (Enterozermina, Linex) – improve the absorption of substances and intestinal microflora;
drugs to reduce the secretion of peptides and reduce production gastric juice- Sandostatin;
antidiarrheal drugs (Lopedium, Imodium) - inhibit intestinal motility;
antacids (Rennie, Gastal, Omeprazole, Maalox) - reduce the risk of developing ulcers and other lesions;
analgesics (Spazmalgon, Analgin) - to reduce pain.

Medicines - gallery

Linex improves the absorption of substances Spasmalgon eliminates pain Allohol increases bile secretion Amoxicillin eliminates bacterial infection Gastal reduces the risk of developing ulcers Imodium - antidiarrheal drug Pangrol replenishes the lack of pancreatic enzymes
Prednisolone is necessary for inflammatory processes Sandostatin reduces the secretion of peptides and reduces the production of gastric juice Ferrum Lek replenishes iron deficiency

Diet for adults and children: use of mixtures Peptamen, Nutrien Elemental, Nutrilon

The principles of nutrition for malabsorption syndrome are as follows:

determine the degree of absorption of nutrients;
avoid taking foods whose elements are difficult to digest;
replace lost components with alternative foods containing essential nutrients;
plan a diet taking into account the cause of the pathology;
drink large amounts of liquid to remove toxic elements.

Doctors recommend that patients include foods in their diet that are high in protein and low in fat. In some cases, enteral (via tube) nutrition products are used, as they contain a suitable composition of proteins, carbohydrates and fats. The most commonly used semi-element mixtures are Peptamen and Nutrien Elemental.

A child is very vulnerable in the first year of his life, so choosing the right diet is an important point. If it is necessary to use infant formula, you need to choose a diet depending on the type of disorder, for example, in case of celiac disease, preference is given to gluten-free formulas. Young patients may be prescribed a special Nutrilon mixture, which improves the absorption of substances.

If there is no possibility of self-feeding, then a special probe is used through which the mixture is supplied. In severe cases, nutrients are administered intravenously.

In addition, patients are assigned table No. 5. At its core - fractional reception food. Allowed products:

crumbly porridge;
skim cheese;
soups with vegetable broth;
lean beef and chicken;
compote;
non-acidic fruits;
weak tea;
lettuce leaves.

Surgical intervention

With the development of concomitant pathologies, surgical intervention is used:

liver transplantation - prescribed for severe liver diseases;
removal of stones from the biliary tract or gallbladder - used for cholelithiasis;
resection of lymphatic vessels located in the intestine - during the development of secondary lymphangiectasia;
removal of the inflamed part of the large intestine - used for Hirschsprung's and Crohn's diseases.

Consequences and complications

Lack of nutrients and low quality their absorption has a noticeable effect on the patient’s body. The long-term nature of the violation can lead to the following consequences:

formation of stones in the kidneys and gall bladder;
rickets;
tumor formation;
ulcerative formations;
anemia;
osteoporosis;
infertility;
slow growth in children.

Malabsorption syndrome is an insidious enemy that is dangerous to underestimate. Do not despair - proper treatment and timely detection of pathology alleviates the patient’s condition and protects the patient from the risk of complications.

Malabsorption syndrome in children, or malabsorption syndrome, is a complex of clinical symptoms that develop due to a disorder in the digestive and transport capacity of the small intestine, and this leads to a deterioration in metabolism. Malabsorption syndrome manifests itself as diarrhea, steatorrhea, multivitamin deficiency, and weight loss.

Causes of malabsorption

Malabsorption can be caused by more than 70 diseases of the digestive system, including megaloblastic anemia, vitamin D-resistant rickets, pathologies associated with impaired amino acid metabolism, etc., but in medicine the term “malabsorption” is applied only to those diseases that are accompanied by deficiency nutrition and enteric syndrome.

Depending on the severity of the disorder, malabsorption is divided into:

1st degree. A person’s weight decreases by less than 10 kg, there are signs of asthenovegetative syndrome and multivitamin deficiency (weakness, apathy, fatigue);
2nd degree. Body weight decreases by more than 10 kg, multivitamin deficiency is severe, electrolyte deficiency, anemia, and decreased function of the gonads are diagnosed;
3rd degree. Body weight deficiency develops, patients suffer from a lack of many vitamins and electrolyte deficiency, convulsions may occur, and anemia, osteoporosis, edema, and endocrine disorders develop against the background of a lack of nutrients.

Malabsorption syndrome can be caused by congenital disorders or develop against the background of acquired diseases

Congenital malabsorption is the cause of 10% of cases of the disorder. It is formed against the background of celiac disease, cystic fibrosis, Shwachman-Diamond syndrome, lactase deficiency, sucrose or isomaltose, disaccharide deficiency, Hartnup disease, cystinuria.

Acquired malabsorption can develop after the child has suffered enteritis, as well as if he suffers from intestinal lymphangiectasia, tropical sprue, short bowel syndrome, small intestinal oncology, chronic pancreatitis, cirrhosis. The syndrome is associated in 3% of patients with intolerance to cow's milk protein, which can develop at any age.

Symptoms

The clinical picture includes nonspecific and specific symptoms. Nonspecific signs include manifestations that occur in many pathologies of the gastrointestinal tract, and on their basis it is impossible to establish a correct diagnosis. These symptoms include:

weakness, fatigue, apathy;
loss of body weight with normal nutrition (this symptom is more pronounced in children with celiac disease and Whipple's disease);
bloating, cramping or girdling pain in the upper part of the abdomen, rumbling, intestinal motility is noticeable to the eye;
flatulence (the release of digestive gases) occurs when there is an excessive amount of bacteria in the small intestine;
diarrhea;
steatorrhea (fatty stool), the volume of stool is increased, they are mushy or watery, foul-smelling, acholic (if too little bile acids enter the intestines).
dry skin, brittle hair and nails, dermatitis, glossitis, ecchymosis.

Specific signs of pathology, that is, those that indicate malabsorption syndrome, are as follows:

peripheral edema. This symptom develops as a result of hypoproteinemia. The feet and legs usually swell. If the syndrome is severe, then ascites forms, which is associated with impaired protein absorption, loss of endogenous protein and hypoalbuminemia;
changes caused by multivitamin deficiency. A sign of hypovitaminosis is changes in the skin, mucous membrane and tongue. In people with a lack of vitamins, the skin is dry and flaky, cheilitis, glossitis, stomatitis develop, age spots appear on the body or face, the nail plates change color and split. Depending on which elements cannot be absorbed in the small intestine, corresponding disorders appear. With a lack of vitamin K, the gums begin to bleed and petechial or subcutaneous bruising occurs. “Night blindness” occurs due to a lack of vitamin A. If there is a deficiency of vitamin D, then patients have pain in the bones. Lack of sufficient amounts of vitamin B 12 leads to the development of megaloblastic anemia, and deficiency of vitamins B 1 and E causes paresthesia and neuropathy;
deviation from the norm of mineral balance. The mineral composition of the blood is disturbed in all people with malabsorption syndrome. Lack of potassium leads to cramps, myalgia, paresthesia, and bone pain. Potassium and magnesium deficiency contributes to increased excitability of the nervous system and positive Chvostek and Trousseau symptoms. In severe cases, when there is a small amount of calcium and vitamin D in the blood, osteoparosis of the tubular bones, pelvis and spine occurs. In patients with impaired absorption of zinc, iron and copper, a rash is visible on the skin, iron deficiency anemia, hyperthermia are detected;
disruption of the endocrine system. With severe and prolonged course of the disorder, signs of polyglandular insufficiency appear. The sex glands cease to function normally (libido and potency decrease, menstruation is disrupted or it disappears altogether). Impaired calcium absorption leads to hyperparathyroidism.

In patients with malabsorption syndrome, of course, there are also signs of the underlying disease, which provoked the absorption disorder

Children are most often diagnosed with:

glucose-galactose malabsorption;
gluten intolerance;
malabsorption of fats, carbohydrates or proteins;
monosaccharide deficiency;
lactose deficiency;
malabsorption of minerals.

If fats enter the large intestine, they also absorb fat-soluble vitamins, which leads to their deficiency. Due to the development of pathogenic microflora, the absorption of bile salts is limited, and these acids irritate the large intestine, which leads to diarrhea.

If carbohydrates are poorly absorbed, then microflora quickly develops in the large intestine, which breaks down incoming carbohydrates into more simple connections, including fatty acids, carbon dioxide and methane, and this provokes diarrhea and increased gas formation. If there is a lack of proteins, then this leads to a lack of amino acids.

Diagnostics

The presence of malabsorption syndrome can be assumed in patients with frequent diarrhea, weight loss and anemia. When collecting anamnesis, it is necessary to clarify when the first symptoms appeared. Congenital intestinal lymphangiectasia most often manifests itself at the age of eleven; celiac disease makes itself felt when the child is 9 months -1.5 years old.

Short bowel syndrome (SBS), against which malabsorption develops, occurs immediately after abdominal surgery. The doctor must determine the sequence of symptoms. This is important because with Whipple's disease, signs of joint damage first appear; with lymphangiectasia, severe, symmetrical swelling and diarrhea initially occur.

It is possible to establish the presence of malabsorption syndrome laboratory methods. The patient must submit blood, urine, and feces for analysis. A clinical blood test for malabsorption reveals anemia, which means that folic acid and iron are poorly absorbed.

If inflammatory-destructive processes also occur in the ileum, then the absorption of vitamin B12 changes and megaloblastic anemia develops. An increase in the level of leukocytes and a high ESR (erythrocyte sedimentation rate) can be interpreted as an exacerbation of the inflammatory process or the development of Crohn's disease.

Prolongation of prothrombin time indicates vitamin K deficiency

Blood biochemistry allows you to evaluate the level of albumin, calcium, and alkaline phosphatase. With malabsorption, hypokalemia, hypocholesterolemia, and hypoferremia are detected. With constant inflammation in the intestines, the level of C-reactive protein increases. An analysis is also taken to determine the amount of vitamins. The level of serum carotene, cobalamin, and folic acid is diagnostically significant.

A lack of vitamin B 12 indicates chronic pancreatitis and pathology of the ileum; a lack of folic acid occurs in celiac disease, tropical sprue, and Whipple's disease. If there is bacterial overgrowth in the small intestine, then folic acid levels are higher than normal and vitamin B 12 levels are lower than normal.

Coprology makes it possible to detect starch and myocytes in feces, which indicates a malabsorption of carbohydrates and proteins. In some diseases, the pH of the stool changes, for example, with disaccharidase deficiency, the result is at least 6.0. A stool examination is also performed to determine steatorrhea. It is normal if 93-95% of incoming fats penetrate into the bloodstream.

With malabsorption of grade 2, the rate is reduced to 60-80%, with grade 3 to 50%. For analysis, stool is collected for three days. Before collecting the material, the patient must adhere to a diet for several days and consume 80-100 grams of fat.

To assess the absorption capacity of the small intestine, a D-xylose test is prescribed. The patient drinks 25 grams of D-xylose on an empty stomach and washes it down with a glass of water, after which he collects urine for 5 hours. An hour after taking the substance, blood is taken from a vein. In children who weigh less than 30 kg, the level of xylose in the blood should be more than 25 mg/dl, and in the urine - at least 5 g. With malabsorption, renal failure, portal hypertension, ascites, these indicators are reduced.

To determine the absorption of vitamin B 12, the Schilling test is prescribed. The patient drinks 1 mcg of the labeled vitamin, and then the laboratory determines how much vitamin is excreted in the urine per day. If less than 5-8%, then this confirms malabsorption. This test may be done twice to check the effectiveness of the prescribed treatment.

For the treatment of malabsorption, its root cause is important; it is instrumental diagnostic methods that make it possible to identify the pathology that led to a disorder of absorption or transport function.

Children over 2 years of age may be prescribed a stool test for the presence of Giardia.

X-ray with contrast allows you to detect blind loops of the small intestine, anastomoses, diverticula, strictures, ulcers, ulcers, fistulas, horizontal levels of gas and liquid, in addition, the images can determine the thickening of the folds of the intestinal mucosa (Whipple's disease, lymphoma, amyloidosis, Zollinger syndrome - Ellison), atrophy (celiac disease), dilation of segments of the small intestine (scleroderma, celiac disease), smoothness of the walls (tropical sprue).

Computed tomography will confirm chronic pancreatitis, enlarged mesenteric lymph nodes, pancreatolithiasis, and an increase in the diameter of small intestinal loops. Endoscopy is performed if the D-xylose test is positive or steatorrhea is present. Visual examination allows diagnosing Whipple's disease, amyloidosis, celiac disease, and intestinal lymphagioectasia.

During the examination, material is taken for histology, and small intestinal contents are aspirated. To confirm the primary disease, other research methods are also carried out, such as assessing the exocrine activity of the pancreas, determining the syndrome of bacterial overgrowth, lactase deficiency and celiac disease.

Treatment

Once malabsorption syndrome has been identified, medical measures are carried out, the purpose of which is to eliminate the signs of malabsorption, eliminate body weight deficiency, cure the underlying pathology that provoked the malabsorption disorder, and prevent the development of complications of malabsorption.

For these purposes, the following measures are being taken:

surgical or medicinal treatment of the primary disease is performed;
the child’s nutrition is adjusted taking into account the clinic;
protein metabolism is restored;
Vitamin deficiency and electrolyte disturbances are eliminated;
motility of the intestinal tract is restored to normal;
normal intestinal microflora is restored;
if necessary, rehydration therapy is carried out.

The child is prescribed a diet in which the amount of protein food is increased (up to 130-150 grams per day) and the fat content is reduced (in case of steatorrhea, approximately two times). The calculation of calories and quality composition of food is carried out taking into account age norm. Children are prescribed specialized formulas that contain nutrients in optimal quantities.

The diet also involves eliminating foods that cause allergic or inflammatory reactions in the small intestine. So, in case of lactose intolerance, foods containing milk fats are removed from the diet; in case of celiac disease, gluten should not be consumed. In severe cases of the disease, enteral or parenteral nutrition may be prescribed.

In some cases, following a diet is sufficient to eliminate the disorder.

To eliminate signs of malabsorption, drug therapy is required, with the help of which the mineral balance of the blood is restored and the amount of vitamins is normalized. Vitamin B 12 may be recommended to be administered parenterally. It is prescribed to children at a dose of 100 mcg/day for 10-15 days, after which the rate is reduced to 60-100 mcg per month.

Nicotinic acid is usually prescribed intramuscularly at 0.5 ml, and then the dose is increased by 0.5 ml and 2 ml is given for two days, then 3 ml for three days, and so on up to 5 ml, then the dosage is reduced. Iron and folic acid are recommended for anemia, they are consumed orally until recovery normal indicators blood.

Folic acid is prescribed to children 1 mg per day. Calcium gluconate should be taken 6-12 tablets per day and serum calcium levels checked every month. If Whipple, Crohn's, tropical sprue, bacterial overgrowth syndrome are diagnosed, then antibacterial therapy is necessary. The use of antibiotics is indicated for a long time (for tropical sprue, antibiotic therapy is 3-6 months, for Whipple's disease - from a year).

People with Crohn's disease, Whipple's disease, or gluten intolerance may be prescribed Prednisolone (a hormonal drug)

To reduce intestinal secretion and inhibit small intestinal motility, Octreotide is used intravenously or subcutaneously (dosage for children 1-10 mcg/kg/day, maximum 1500 mcg per day) or Loperamide orally (children 2-5 years old, 1 mg twice a day, children from 5 years old, give 2 mg twice a day).

Choleretics are prescribed if malabsorption syndrome is caused by chronic liver pathology or short bowel syndrome. Ursodeoxycholic acid is given to children at the rate of 8-10 mg per kilogram of weight (but not more than 300 mg/day), the dose is divided into two doses. It may also be recommended to take Phenobarbital (3-8 mg/kg) 2-4 times a day.

For pancreatic dysfunction (Whipple's disease, chronic pancreatitis, cystic fibrosis), enzyme therapy is used. The dosage is selected individually and depends on the age of the patient and the clinic. Creon, Mezim forte, Pancitrate may be prescribed. The lack of effect of treatment may be due to increased acidity of gastric juice, in which case the use of proton pump inhibitors or H2 receptor antagonists is required.

Surgical intervention is carried out only for pathology that provokes malabsorption syndrome. Surgery may be necessary for Crohn's disease, Hirschsprung's disease, liver pathology, complications of inflammation of the large intestine, and intestinal lymphangiectasia. The duration of treatment for malabsorption syndrome depends on the primary disease that caused the malabsorption disorder.

If malabsorption has developed against the background of infectious enteritis, then therapy can only consist of treating the underlying disease and following a diet for a week; for celiac disease, the diet must be followed for life, and correction of vitamin deficiency and electrolyte balance should be carried out during the entire recovery period (up to six months).