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Chapter: Paediatrics: Gastroenterology and nutrition

Paediatrics: Malabsorption

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



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.










   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.




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.




   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




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




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




Immunodeficiency syndromes, e.g. HIV


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


   Bacterial overgrowth, e.g. pseudo-obstruction


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