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MALABSORPTION AND CELIAC DISEASE

Key Clinical Questions Malabsorption and Celiac Disease

  • image Does this patient have malabsorption?

  • image Is the malabsorption due to celiac disease?

  • image What other diseases need to be considered?

  • image What are the consequences of malabsorption?

  • image How is malabsorption managed?

Small Bowel Obstruction
  • image How do patients present with small bowel obstruction?

  • image When do patients with small bowel obstruction need to go to surgery and when can they be managed medically?

Small Bowel Ileus
  • image How is small bowel ileus treated?

  • image When can a patient resume oral intake?

Acute Mesenteric Ischemia
  • image Does this patient have acute mesenteric ischemia?

  • image How does mesenteric ischemia differ from colonic ischemia?

  • image Is emergent surgery necessary?

EPIDIEMIOLOGY

Numerous causes lead to malabsorption and maldigestion, ranging from the common to the obscure. Causes of malabsorption and maldigestion include celiac disease, small bowel bacterial overgrowth, Crohn disease with small bowel involvement, chronic pancreatitis, short bowel syndrome, protein losing enteropathy, intestinal lymphangiectasias, amyloid, small bowel lymphoma, eosinophilic gastroenteritis, common variable immunodeficiency, lactose intolerance and other disaccharidase deficiencies, and Zollinger-Ellison syndrome (Table 162-1).

TABLE 162-1Disorders Associated with Malabsorption

Lactose intolerance is a common cause of maldigestion. It is present in 7% to 20% of Caucasian adults, 50% of Hispanics, 65% to 75% of African Americans, and 90% of some East Asian populations. Celiac disease is most commonly seen in whites of northern European ancestry. In a large screening study from the United States, the prevalence of celiac disease in average risk individuals was 1:133. The prevalence was highest in first-degree relatives of a patient with celiac disease (1:22). Other disorders, such as primary intestinal lymphangiectasias, occur so rarely that it is difficult to estimate their true prevalence.

RISK STRATIFICATION

While generally managed as outpatients, patients with severe malnutrition or dehydration may need admission for nutritional support, volume repletion, and to correct electrolyte abnormalities. Significant weight loss (>10%) is associated ...

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