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Chapter: Paediatrics: Gastroenterology and nutrition

Paediatrics: Malabsorption

Defined as subnormal intestinal absorption of dietary constituents with excessive faecal nutrient loss.

Malabsorption

 

Defined as subnormal intestinal absorption of dietary constituents with excessive faecal nutrient loss. The prognosis depends on the cause. Reduced adult height, teeth enamel defects, and osteoporosis may result from long-term malabsorption. Causes are listed in Box 10.5.

 

Presentation

 

   Diarrhoea.

 

   Steatorrhoea.

 

   Flatulence.

 

   FTT/weight loss.

 

   Muscle wasting.

 

   Abdominal distension.

 

   Peri-anal excoriation.

 

   Delayed puberty.

 

   Features of underlying illness, e.g. abdominal pain in Crohn’s disease.

 

   Signs of nutritional deficiency states, e.g. ascites due to hypoalbuminaemia.

 

Investigations

 

Initial screening tests should include: FBC; U&E; creatinine; albumin; total protein; Ca2+; PO43– ; LFT; iron status, coeliac antibody screen; coagulation screen, stool M,C&S.

If diagnosis still unclear, consider:

   Upper GI endoscopy with biopsy to look for an enteropathy, ileocolonoscopy if features suggest colitis (ensure clotting screen normal before procedure).

   Sweat test.

   Immune function tests.

   Faecal fat measurement.

   Facal elastase.

   Faecal A1-antitrypsin.

   Exocrine pancreatic function tests.

 

Treatment

 

   Treat underlying disease, e.g. metronidazole for giardiasis, gluten-free diet for coeliac disease.

   Supplemental digestive enzymes, e.g. pancreatic enzymes in cystic fibrosis.

   Nutritional supplements to correct deficiencies.

   PN if malabsorption severe or slow to recover.

 

Box 10.5 Causes of malabsorption

 

Intraluminal digestive defect

 

Carbohydrate intolerance (most commonly lactose intolerance)

 

Protein–energy malnutrition

 

Cystic fibrosis

 

Shwachman–Diamond syndrome

 

Chronic pancreatitis

 

Cholestasis

 

Pernicious anaemia

 

Specific digestive enzyme deficiency, e.g. lipase

 

Mucosal abnormality

 

Coeliac disease

 

Short bowel syndrome

 

Dietary protein intolerance, e.g. milk protein allergy

 

Intestinal infection or parasites, e.g. giardiasis

 

IBD

 

Abetalipoproteinaemia (disorder of lipid metabolism—FTT, steatorrhoea, progressive ataxia, retinitis pigmentosa, acanthocytes on FBC)

 

Protein–energy malnutrition; intestinal venous or lymphatic obstruction, e.g. congestive cardiac failure, intestinal lymphangiectasia

 

Miscellaneous

 

Immunodeficiency syndromes, e.g. HIV

 

   Drug reaction, e.g. cytotoxics, post-radiation

 

   Bacterial overgrowth, e.g. pseudo-obstruction

 

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Paediatrics: Gastroenterology and nutrition : Paediatrics: Malabsorption |


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