Malabsorption means the gut cannot properly digest or absorb nutrients such as fat, protein, vitamins or minerals. Common causes include celiac disease, chronic pancreatitis, Crohn disease, bacterial overgrowth and prior bowel surgery.
Key symptoms
- Chronic diarrhea with pale, greasy, foul-smelling stools that float
- Weight loss despite eating well
- Bloating and gas
- Fatigue from anemia
- Easy bruising, bone pain or tingling from vitamin deficiencies
What you find on exam
- Weight, BMI and muscle wasting
- Pallor, mouth sores or a smooth tongue
- Edema from low protein
- Itchy blistering rash on elbows and knees (dermatitis herpetiformis)
Tests
- Blood count, iron, B12, folate, vitamin D, albumin, INR
- Celiac serology: tTG-IgA with total IgA
- Fecal elastase for pancreatic insufficiency; stool fat
- Endoscopy with small bowel biopsy; breath test for bacterial overgrowth
Treatment basics
- Treat the cause: strict gluten-free diet for celiac disease
- Pancreatic enzyme replacement for pancreatic insufficiency
- Antibiotics such as rifaximin for bacterial overgrowth
- Replace vitamins (A, D, E, K, B12), iron and calcium
- Dietitian support for calories and protein
Red flags
- Severe weight loss or signs of malnutrition
- Bleeding from vitamin K deficiency
- Severe diarrhea with dehydration or electrolyte problems
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.