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Malabsorption Syndrome

Published on Jan 05, 2019 and last reviewed on Jan 10, 2023   -  4 min read


Malabsorption syndrome is a group of condition where the small intestine is unable to absorb enough nutrients into the bloodstream from the food that you eat. It causes excessive defecation, nutritional deficiency, and gastrointestinal symptoms.

Malabsorption Syndrome


Malabsorption syndrome is a group of condition where the small intestine is unable to absorb enough nutrients into the bloodstream from the food that you eat. The nutrients that the small intestine has problem absorbing are macronutrients like proteins, carbohydrates, and fats, or micronutrients like vitamins and minerals or both. Malabsorption can be total, where absorption of all nutrients is impaired, or partial, where only specific nutrients are not absorbed. It causes excessive defecation, nutritional deficiency, and gastrointestinal symptoms.


Digestion involves mechanical process and enzymatic hydrolysis to break down the food. The mechanical process includes chewing, churning and to and fro mixing of the food in the stomach and small intestine. Enzymatic hydrolysis is achieved by gastric, pancreatic, and biliary secretions. The final products of digestion are then absorbed by the epithelial cells of the small intestine. Any alteration or pathological interference in the above stages causes malabsorption, as it disturbs the typical sequence of digestion, absorption, and transport of nutrients.


The main cause of is some defect or damage to the mucosal lining of the small intestine. It can broadly be classified into premucosal, mucosal, and postmucosal malabsorption.

  1. Premucosal: Caused due to diseases and conditions that cause impaired digestion by affecting the secretion of digestive enzymes. Digestion is impaired in conditions like pancreatitis, pancreatic cancer, and cystic fibrosis. They affect the pancreatic enzyme secretion. Cholestatic liver disease, biliary atresia, and bacterial overgrowth reduce the bile salt concentration in the intestines.
  2. Mucosal: It is due to the conditions that affect the intestinal mucosa and reduce the absorptive area. For example, celiac disease, inflammatory bowel disease, short bowel syndrome (SBS), and Whipple’s disease.
  3. Postmucosal: Impaired absorption due to conditions that result in impaired nutrients transport in the body by vascular and lymphatic obstruction. For example intestinal lymphangiectasia, macroglobulinemia, etc.

The small intestine can also get damaged by the following:

  • Infections caused by bacteria, viruses, or parasites, inflammation, trauma, or surgery.
  • Prolonged use of antibiotics.
  • Radiation therapy.
  • Use of certain drugs like Tetracycline, Cholestyramine, Colchicine, etc.
  • Gallbladder diseases.

Once the lining gets damaged, the nutrients are not absorbed and they pass through your stool.


The symptoms depend on the nutrient that is not being absorbed into the body. The other symptoms are as a result of that specific nutrient deficiency. The general symptoms are

  • Persistent diarrhea.
  • Foul smelling stool.
  • Light colored or bulky stool (Steatorrhea).
  • Weight loss.
  • Scaly skin.
  • Dry hair, hair fall, and edema due to protein deficiency.
  • Anemia due to vitamin B12, folic acid, and iron deficiency.
  • Malnutrition, weight loss, low blood pressure, and muscle wasting.
  • Some females might stop menstruating.

Risk Factors:

The risk factors include:

  • Stomach flu in children.
  • Cancer patients.
  • People who use antibiotics and laxatives frequently.
  • After gastric surgeries like bariatric surgery.
  • Parasitic intestinal infection.
  • Consuming a lot of alcohol.


If you are suffering from persistent diarrhea or deficiency even after consuming a healthy diet, your doctor will perform specific tests to diagnose your condition. They will also look for the diseases that might cause impaired absorption. These tests include:

  • Stool Tests: Stool or feces samples are tested for fat. The presence of too much fat is a sign of malabsorption.
  • Blood Tests: The levels of nutrients like vitamin B12, vitamin D, iron, calcium, albumin, protein, and phosphorus are measured in the blood. Low levels of one or many of these nutrients might indicate impaired absorption or reduced intake.
  • Sweat Test: Sweat sample is tested in the diagnosis of cystic fibrosis. Cystic fibrosis causes a lack of enzymes to digest food.
  • Breath Test: Breath test is used to diagnose lactose intolerance. The unabsorbed lactose gets broken down by the bacteria in the colon to form hydrogen gas. This hydrogen gas gets into the bloodstream and enters the lungs, from where it gets exhaled. The breath of the patient gets tested for this hydrogen gas.
  • Biopsy: A small tissue sample is collected from the inside of the small intestine. This tissue is then studied for signs of infection or other problems. The biopsy is usually collected during endoscopy.
  • CT Scan: CT scan can be used to see the structural changes of the small intestine. For example, a thickened intestinal wall can be a sign of Crohn’s disease.


The treatment depends on the cause.

  • You will be given nutrients and fluids that your body is not able to absorb. And your doctor will treat the health condition that is causing this impaired absorption.
  • A dietician will create a diet plan for you, which will include nutrients that can be easily absorbed by your body, and other supplements to treat nutritional deficiency. They might give you enzyme and vitamin supplements.
  • If the cause is increased peristaltic movement of the digestive tract, then medicines are prescribed to relax it. This makes the passing food stay in the intestine longer, thus giving it more time to get absorbed into the bloodstream.
  • Any infection of the digestive tract can be treated by antibiotics.

If you or your child have any of the sign or symptom of malabsorption, like diarrhea from a long time, it is best you consult your physician and get tested right away. Lack of essential nutrients will prevent healthy growth and development of your child. The earlier you recognize the signs and get treated, the less will be the permanent damage to your body.


Frequently Asked Questions


Can Malabsorption Be Cured?

Yes, mild cases of malabsorption can be cured. Treatment of malabsorption syndrome primarily depends on the cause. It includes the addition of a special diet that is capable of getting easily digested and absorbed in the gut. The affected individuals can be provided with supplements as compensation to nutrients that are not being absorbed well normally.


What Is the Clinical Presentation of Fat Malabsorption?

When patients are diagnosed with fat malabsorption, they are often noted to lose weight in spite of adequate intake of food. Chronic diarrhea has been noted as the most common symptom in the evaluation of these patients. These patients will also have steatorrhea, which is nothing but a fatty stool. It is the hallmark symptom of malabsorption syndrome. These stools are foul-smelling, pale, bulky, and greasy in appearance.


Does Crohn's Disease Belong to Malabsorption Syndrome?

Yes, Crohn's disease belongs to malabsorption syndrome. In Crohn's disease, the small intestine lacks the ability to absorb nutrients properly. This results in malabsorption. The reason behind this is the inflamed intestinal tract with Crohn's disease.


What Are the Foods That Cause Malabsorption?

The following are the foods that are most commonly associated with malabsorption of food:
- Dairy products.
- Grains.
- Gluten-containing foods.
- Foods that can cause intestinal gas build-ups.
- Beans.
- Cabbage.


Which Vitamin Deficiency Can Cause Malabsorption Syndrome?

Low blood levels of carotene can suggest a deficiency in the absorption of fat-soluble vitamins. It can also indicate the dietary deficiency of these vitamins. Vitamin B12 and folate levels are the nutrients that are chiefly low in the patients affected by malabsorption syndrome.


Can Probiotics Help in Treating Malabsorption?

Yes, probiotic supplements can help in treating malabsorption. This is because probiotic supplements are noted to have lactic acid bacteria and bifidobacterium in them. These bacteria effectively support beneficial microbes, especially in the small intestine, by promoting barrier integrity. By doing so, it is noted to treat malabsorption significantly.


Can Malabsorption Be Triggered by Stress?

Yes, malabsorption can be triggered by stress. This is because stress is capable of affecting digestion. In normal patients, the intestines are physiologically coded to have a tight barrier in order to protect the body from food-related to bacterial infections. Stress can make a decrease in the strength of the intestinal barrier. This can lead to malabsorption in certain individuals.


Can Inflammatory Bowel Syndrome Cause Malabsorption Syndrome?

A number of factors related to inflammatory bowel diseases such as Crohn's disease can contribute to malabsorption development. A persistent, chronic inflammation of the small intestinal lining in people affected with small bowel Crohn's disease can often lead to the damage of the intestinal lining. This can, in turn, lead to malabsorption.


Can Malabsorption Make Me Tired?

Since malabsorption primarily causes diarrhea, it can consume a lot of energy. On the other hand, malabsorption also prevents the body from absorbing the essential vitamins and nutrients that are needed to make energy. Thus, due to all these factors there is loss of energy and fatigueness.


Can Gallbladder Diseases Be a Cause of Malabsorption?

Persistent steatorrhea occurs as a result of diseases of the biliary tract, pancreas, or intestine. Fat absorption is primarily dependent upon bile, pancreatic lipases, and normal intestine function. Any problem in these functions can lead to malabsorption.


How Can I Fix Malabsorption?

You can fix malabsorption with the help of a dietician. They might provide you the following.
- Enzyme supplements help your body absorb the nutrients that cannot be absorbed on its own.
- Vitamin supplements.
- Dietary changes to avoid foods that trigger malabsorption.


What Happens to Your Body When You Have Malabsorption?

When a normal person intakes a healthy meal, it is expected that your body will use the benefits of the vitamins and minerals from that food. But in a person affected with malabsorption syndrome, their body will not be able to absorb nutrients from the food they eat. This digestive issue can cause symptoms of bloating and diarrhea.


Can Malabsorption Cause Lose of Weight?

Yes, malabsorption can cause loss of weight. This is because malabsorption can lead to almost all deficiencies, such as fats, proteins, etc. Due to this reason, patients with malabsorption are usually noted to lose weight, and they have difficulty maintaining healthy body weight.


What Is the Appropriate Diet of Malabsorption Syndrome?

The appropriate diet in a person with malabsorption syndrome has to be customized based on its exact cause of malabsorption. The various diet modifications include:
- A gluten-free diet in patients with celiac disease.
- A lactose-free diet in patients with lactose intolerance.
- The use of protease and lipase supplements in patients with pancreatic insufficiency.


How to Diagnose Malabsorption Syndrome?

In the process of diagnosing a malabsorption syndrome, the primary tools are a detailed and thorough history and physical examination. In addition to the details collected from the history and physical examination, the doctor may also order several tests to find the exact cause of the problem. It includes:
- Complete blood count.
- Abdominal X-Ray.
- Stool test.
- Lactose hydrogen breath test:


How to Increase Vitamins Levels With Malabsorption Syndrome?

By incorporating the following lifestyle changes, you can increase vitamin levels in a person with malabsorption syndrome:
Add a variety of foods in one meal. It should not include the foods that trigger your malabsorption.
- Add vitamin C-rich foods with iron supplements.
- Add healthy fats with your regular diet.
- Take a probiotic.
- Avoid drinking tea in-between meal times.


What Are the Types of Malabsorption Syndromes?

The following are the various types of malabsorption syndromes:
Digestive failure due to abdominal trauma or a chronic disease process.
- Bile acid or bile salt malabsorption.
- Bacterial overgrowth.
- Obstructive jaundice.
- Primary bile acid diarrhea.
- Crohn's disease.
- Carcinoma of pancreas.
- Chronic pancreatitis.
- Celiac disease.
- Cystic fibrosis.
- Zollinger-Ellison syndrome.


How Is Malabsorption Treated?

The primary treatment of malabsorption includes consuming foods that trigger malabsorption. Diarrhea has to be treated with the help of antidiarrheals. Dehydration due to diarrhea has to be addressed through intravenous infusion of fluids and colloids. Definitive treatment would involve diet modifications and vitamins and enzyme supplements.

Last reviewed at:
10 Jan 2023  -  4 min read




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