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For further information, see CMDT Part 15-27: Malabsorption
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Many patients are asymptomatic
Flatulence, weight loss, abdominal pain, diarrhea, and sometimes steatorrhea
May also be present in a subset of patients with irritable bowel syndrome
Advanced cases associated with deficiencies of iron or vitamins A, D, and B12
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Stool fecal fat: corroborates presence of steatorrhea
Small bowel CT or MR enterography or barium radiography: identifies mechanical factors predisposing to intestinal stasis
Small intestinal biopsy
Aspirate and culture of proximal jejunal secretion
Noninvasive breath tests are reported to have a sensitivity of 60–90% and specificity of 85% compared with jejunal cultures
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Correct the anatomic defect when possible
Ciprofloxacin, 500 mg twice daily orally, norfloxacin, 400 mg twice daily orally, amoxicillin clavulanate, 875 mg twice daily orally, or combination of metronidazole, 250 mg three times daily orally, and trimethoprim-sulfamethoxazole 160/800 mg twice daily orally, or cephalexin, 250 mg four times daily orally, for 1–2 weeks
Rifaximin, 400 mg three times daily orally, is a nonabsorbable antibiotic that is effective and appears to have fewer side effects than systemic antibiotics
If symptoms recur off antibiotics, cyclic therapy (eg, 1 week of every 4) may be sufficient
Avoid continuous antibiotics to prevent bacterial antibiotic resistance
Octreotide in small doses may be of benefit