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Key Clinical Questions Malabsorption and Celiac Disease

  • Image not available. Does this patient have malabsorption?

  • Image not available. Is the malabsorption due to celiac disease?

  • Image not available. What other diseases need to be considered?

  • Image not available. What are the consequences of malabsorption?

  • Image not available. How is malabsorption managed?

Small Bowel Obstruction
  • Image not available. How do patients present with small bowel obstruction?

  • Image not available. When do patients with small bowel obstruction need to go to surgery and when can they be managed medically?

Small Bowel Ileus
  • Image not available. How is small bowel ileus treated?

  • Image not available. When can a patient resume oral intake?

Acute Mesenteric Ischemia
  • Image not available. Does this patient have acute mesenteric ischemia?

  • Image not available. How does mesenteric ischemia differ from colonic ischemia?

  • Image not available. Is emergent surgery necessary?


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.


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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