Why does maldigestion syndrome occur, its symptoms and treatment?

Maldigestion (or digestive insufficiency syndrome) is a whole complex of symptoms associated with a disruption in the process of breaking down vital nutrients (nutrients) into components acceptable for digestion, caused by a lack of digestive enzymes and a number of other reasons.

Accompanying almost every pathology of the gastrointestinal tract, it sometimes manifests itself from the first days of life in newborns suffering from congenital pathologies. A close connection between maldigestion and malabsorption syndrome (a chronic disorder of the processes of breakdown, transport and absorption of nutrients in the small intestine) has been established.

Provoking malnutrition, maldigestion can become the culprit not only of a significant decrease in body weight, but also of more serious physiological changes associated with the fact that insufficiently digested food gruel (chyme) can become an excellent breeding ground for pathogenic microflora, as well as an inexhaustible source of a huge number of antigens giving impetus to the occurrence of allergic reactions.

Being a multi-step process designed to transform complex nutrients into simpler ones that can be absorbed by the human body, digestion plays a key role in it. That is why even minor disturbances in this process can significantly worsen the condition of the entire organism.

Maldigestion, which accompanies most gastrointestinal diseases, in this context appears to be an extremely common and pressing problem. In elderly people, under the influence of inevitable age-related processes, maldigestion takes on a special – involutive – form.

Causes

Maldigestion syndrome develops due to a violation of the secretory function of the intestines and pancreas, since insufficient enzymes are synthesized for normal digestion.
The appearance of the disorder can be facilitated by biliary dysfunction, intestinal dysbiosis, impaired intestinal motor function, endocrine pathologies and other concomitant diseases. Maldigestion syndrome can occur as a result of:

• disorders of cavity digestion. The reason, as a rule, is exocrine pancreatic insufficiency, which develops in diseases of the pancreas (tumor, fistulas, pancreatitis, anatomical disorders, cystic fibrosis). The activity of digestive enzymes decreases with stomach ulcers and gastroduodenitis, as well as with impaired chyme movement in IBS (irritable bowel syndrome), diarrhea, stenosis, and after surgery. The level of enzymes decreases due to dysbiosis, gastrogenic insufficiency, lack of bile acids, which is caused by diseases of the liver and small intestine;
• violations of parietal digestion. Develops as a result of death or degeneration of intestinal cells (enterocytes). Cell death is caused by Crohn's disease, sarcoidosis, an inflammatory process of any etiology, and celiac enteropathy;
• disorders of intracellular digestion. Normal intracellular digestion cannot occur with a deficiency of disaccharidases (the disorder can be either congenital or acquired).

Maldigestion syndrome can develop due to poor nutrition, diet, or excessive consumption of fermented drinks
. Enzyme deficiency can be congenital. There are enzymopathies associated with the absence of disaccharidases (lactase, saccharidase, isomaltase), lack of peptidases (gluten is not broken down), and enterokinase deficiency (trypsinogen breaks down into trypsin).

In case of disaccharidase or peptidase deficiency, it is necessary to refuse food that contains components that cannot be broken down, and in case of enterokinase deficiency, the pancreatic secretion is not activated at all, so lifelong replacement therapy is required.

Acquired fermentopathy can develop due to poor nutrition, when the balance of proteins, fats and carbohydrates is not maintained (fully corrected by diet).

Maldigestion syndrome also develops in all diseases of the stomach, small intestine, gallbladder, liver, pancreas associated with the production of digestive secretions (bile, gastric, intestinal and pancreatic juice).

For example, with hypoacid gastritis, insufficient hydrochloric acid is synthesized, and this leads to the fact that pepsinogen is not activated, which means that protein denaturation does not occur. Congenital enteropathies usually appear at an early age. Lactase deficiency can be either congenital or acquired, since in an adult the synthesis of lactase gradually decreases and may stop altogether.

Diseases of the endocrine system (diabetes mellitus, thyroid disease) can also lead to impaired digestive function. With increased peristalsis of the intestines or stomach, the chyme does not have time to be processed by digestive juices. So, if the contents of the stomach enter the duodenum too early, then enzymes will not be able to break it down, and hydrochloric acid will penetrate into the intestine, which has not had time to be neutralized in the antrum of the stomach.

With intestinal dysbiosis, the upper part of the small intestine is populated by a large number of microorganisms that destroy digestive enzymes, provide deconjugation of bile acids and the formation of putrefactive and fermentative dyspepsia.

There is an involutive form of the disorder, which develops against the background of age-related changes in the body. It is typical for older people. The fact is that with age, less hydrochloric acid is synthesized in the stomach, not so much bile is secreted in the liver, and peristalsis decreases. All this leads to a slowdown in digestion and difficulties in breaking down heavy foods.

Poor digestion provokes the development of certain processes that negatively affect the entire body.

Kinds

Enzymopathies with maldigestion can be congenital or acquired. Congenital diseases are represented by:

• Insufficiency of disaccharidases - special intestinal enzymes (isomaltase, lactase, saccharidase) that ensure the digestion of disaccharides (the most common compounds of this group of carbohydrates are lactose, maltose and sucrose). Disaccharidase-deficient enteropathies manifest themselves by the occurrence of disorders accompanying the digestion of products containing the above disaccharides. The most striking example of such fermentopathy is intolerance to milk and dairy products, which is explained by a lack of lactase in the human body. Since lactose is the main component of any (including mother's) milk, treatment of severe forms of lactase deficiency in infants, which manifests itself from the first days of their life, is an extremely difficult task. When consuming milk and products containing it, any person with lactase deficiency experiences bloating, watery foamy diarrhea and discomfort in the intestines. It has been established that with age, lactase activity decreases significantly even in initially healthy people.
• Peptidase deficiency. In the medical literature, this congenital pathology is called celiac disease or celiac enteropathy. The main cause of digestive disorders in celiac disease is damage to the intestinal villi - special absorption organs - by a number of foods containing gluten and related proteins found in cereals: rye, oats, wheat, barley. Damage to the villi leads to chronic diarrhea and steatorrhea, a pathology consisting of the excretion of large amounts of fat in the feces.
• Enterokinase deficiency. The main purpose of this digestive enzyme is to convert the proenzyme trypsinogen into the enzyme trypsin. Enterokinase deficiency can jeopardize the success of the digestive process, since trypsin, which is part of pancreatic juice in the form of trypsinogen, may remain in an unactivated state. The consequences of this rather rare congenital anomaly can be prevented if, after a timely diagnosis, adequate treatment, consisting of a special diet and replacement therapy, is started in the first weeks of a newborn’s life. The main clinical manifestations of enterokinase deficiency are: severe developmental abnormalities, malnutrition (chronic pathology of digestion and nutrition in young children, characterized by exhaustion), vomiting, and diarrhea.

The group of acquired enzymopathies includes:

• Cases of nutritional fermentopathy, developing as a result of poor-quality nutrition, characterized by an imbalance in the ratio of nutrients (fats, proteins, carbohydrates, macro- and microelements) in the food taken and often leading to protein starvation. The only method of correcting this pathology is to normalize nutrition.
• Anomalies characterized by insufficient digestion of food in the stomach, caused by insufficient production of hydrochloric acid, which prepares food for further stages of digestion.
• Digestive pathologies that arise from intestinal diseases: Crohn's disease, chronic enteritis, as well as conditions that develop after surgery on the small intestine. Each disease is characterized by a separate set of clinical manifestations.
• Diseases of the auxiliary organs of the digestive system.
• Digestive disorders caused by taking certain medications: for example, antibiotics that can cause intestinal dysbiosis. Cytostatic drugs and radiation therapy sessions used to treat cancer can have an equally strong effect on the intestinal microflora.
• Cases of involutional maldigestion caused by the inevitable effect of age-related changes occurring in the intestines of elderly people. Considering the extreme deterioration of all body systems, a significant decrease in the secretion of digestive enzymes and hydrochloric acid, and weakened intestinal motility, the only way to alleviate the condition of elderly patients is to take replacement medications and switch to easily digestible food.

Symptoms characteristic of SMA

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Despite the fact that malabsorption syndrome is inherent in various diseases, it is possible to identify signs characteristic of it. With SMA, nausea and vomiting occur. Patients' appetite worsens. Symptoms such as flatulence and changes in stool (most often diarrhea) are also observed. All these signs are called dyspeptic syndrome. He is a leader in the clinical manifestations of SMA.

The chair deserves special attention. By assessing the characteristics of feces, specialists receive important information that allows them to make the correct diagnosis:

• loose and foamy stools with a sour odor - a symptom that may be inherent in pathologies such as glucose-galactose malabsorption, disaccharidase deficiency;
• fatty stools occur with chronic pancreatitis, cystic fibrosis, dermatitis herpetiformis, exudative enteropathy, Pearson syndrome, intestinal dysbiosis;
• very fatty stools are observed in cystic fibrosis, congenital lipase deficiency;
• watery diarrhea is a symptom that can occur when infections enter the body, enterocolitis, and malabsorption of glucose and galactose develop.

SMA sometimes causes pain. Most often they are caused by intestinal infections and infestations. Pain syndrome can be observed after consuming dairy products. It, combined with foamy stools with a sour odor and flatulence, indicates lactase deficiency. Abdominal pain in SMA accompanies food allergies, intestinal abnormalities, Whipple's disease, ulcerative colitis, and Crohn's disease. With malabsorption syndrome, the following symptoms are also observed:

• skin rashes;
• fatigue;
• feeling of weakness;
• bloating;
• anorexia.

Malabsorption in children is accompanied by deficiency syndromes. Physical development is impaired. This manifests itself in a decrease in body weight, the development of malnutrition, and growth retardation. Vitamin deficiency is indicated by the condition of the skin. The skin becomes dry and begins to peel. Pigment spots appear on it. Hair becomes thinner and begins to fall out. Nails become dull and peel. With calcium deficiency, cramps and pain in muscles and bones occur. Lack of iron, copper and zinc leads to skin rashes, the development of iron deficiency anemia, and increased body temperature.

Symptoms

Maldigestion syndrome is characterized by the appearance of the following conditions:

• flatulence;
• diarrhea;
• constipation;
• nausea, vomiting;
• belching;
• an increase in the amount of feces, a change in their color and smell;
• pain;
• bloating.

However, the leading symptom is intolerance to any food product.

The pathological condition has distinctive features as it develops in a child’s body.

Symptoms of this syndrome in children are as follows:

• foul-smelling loose stools;
• the stomach increases in size;
• pain in the navel area;
• vomit;
• dysphagia (difficulty swallowing);
• underweight and stunted growth;
• atopic dermatitis;
• sensitive, restless sleep, irritability.

Also, the child’s illness is accompanied by frequent colds and stomatitis. An exacerbation of signs of the pathological condition occurs in the afternoon. Weakness in the body, lack of appetite, and weight loss are also present with this syndrome.

Malabsorption syndrome is a direct complication of maldigestion syndrome, which is provoked by the lack of timely treatment.

It has the following symptoms:

• regular weight loss;
• state of apathy;
• a pronounced feeling of weakness in the body;
• dry skin;
• hair fragility.

Women experience menstrual irregularities.

Pathophysiology

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Pathophysiology consists of several stages:

• hydrolysis of carbohydrates, fats and proteins involving enzymes in the process;
• digestion by brush border, capture of final products;
• transport of nutrients into the lymph.

In the process of the syndrome, nutrients (nutrients necessary for human life) are broken down into components that satisfy digestion and are deficient in nutrients. Maldigestion and malabsorption are closely related, since the latter syndrome is a chronic disorder of the breakdown, movement and absorption of nutrients.

Treatment methods

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The goal of therapy is to eliminate the signs of the disorder, but this is impossible without eliminating the cause of malabsorption. Treatment is carried out in several stages:

• elimination of symptoms;
• weight normalization;
• identifying the cause and eliminating it;
• neutralization of consequences;
• adherence to the regimen to prevent relapse.

Drug treatment method

Prescription of medications is one of the methods of treating malabsorption. Depending on the type of disorder, the following may be prescribed:

• vitamins and minerals (Folacin, Nicotinamide, Sufer, Ferrum Lek) - elements that are not absorbed by the body are used;
• antibiotics (Gentamicin, Amoxicillin, Novosef, Doxycycline, Bactrim) - used for infectious lesions;
• hormonal therapy (Prednisolone) - prescribed for Crohn's disease, celiac disease and other inflammatory processes;
• pancreatic drugs (Mezim, Pangrol, Creon) - compensate for the lack of pancreatic enzymes;
• choleretic agents (Allohol, Nikodin, Ursofalk) - increase the secretion of bile;
• probiotics (Enterozermina, Linex) – improve the absorption of substances and intestinal microflora;
• drugs to reduce the secretion of peptides and reduce the production of gastric juice - Sandostatin;
• antidiarrheal drugs (Lopedium, Imodium) - inhibit intestinal motility;
• antacids (Rennie, Gastal, Omeprazole, Maalox) - reduce the risk of developing ulcers and other lesions;
• analgesics (Spazmalgon, Analgin) - to reduce pain.

Medicines - gallery

Diet for adults and children: use of mixtures Peptamen, Nutrien Elemental, Nutrilon

The principles of nutrition for malabsorption syndrome are as follows:

• determine the degree of absorption of nutrients;
• avoid taking foods whose elements are difficult to digest;
• replace lost components with alternative foods containing essential nutrients;
• plan a diet taking into account the cause of the pathology;
• drink large amounts of liquid to remove toxic elements.

Doctors recommend that patients include foods in their diet that are high in protein and low in fat. In some cases, enteral (via tube) nutrition products are used, as they contain a suitable composition of proteins, carbohydrates and fats. The most commonly used semi-element mixtures are Peptamen and Nutrien Elemental.

A child is very vulnerable in the first year of his life, so choosing the right diet is an important point. If it is necessary to use infant formula, you need to choose a diet depending on the type of disorder, for example, in case of celiac disease, preference is given to gluten-free formulas. Young patients may be prescribed a special Nutrilon mixture, which improves the absorption of substances.

Nutrilon helps cope with the symptoms of the disease

In addition, patients are assigned table No. 5. It is based on fractional meals. Allowed products:

• crumbly porridge;
• skim cheese;
• soups with vegetable broth;
• lean beef and chicken;
• compote;
• non-acidic fruits;
• weak tea;
• lettuce leaves.

It is prohibited to use:

• coffee;
• ice cream;
• semi-finished products;
• fatty and fried meat;
• pepper;
• mustard;
• fresh baked goods;
• alcoholic products;
• fatty fish.

Prohibited foods for malabsorption - gallery

• liver transplantation - prescribed for severe liver diseases;
• removal of stones from the biliary tract or gallbladder - used for cholelithiasis;
• resection of lymphatic vessels located in the intestine - during the development of secondary lymphangiectasia;
• removal of the inflamed part of the large intestine - used for Hirschsprung's and Crohn's diseases.

Diet and nutrition

Diet plays an important role in the treatment of maldigestion.
Maldigestion, as a syndrome indicating the presence of a disease, requires prompt treatment, through not only medications, but also diet. Failure to follow the diet can significantly slow down or stop the treatment process altogether.

Features of the diet for maldigestion:

• Eating foods high in protein (approximately 125-155 g per day). Protein is found in fish, poultry, nuts;
• Rational fractional meals (5-6 times a day);
• Do not eat too cold or hot food;
• A balanced diet (it is important to take into account the calorie content of foods and their chemical composition);
• If you are lactose intolerant, avoid carbohydrates contained in dairy products that cause diarrhea;
• Exclude bakery and confectionery products containing margarine and yeast, semi-finished products;
• Include lactose-free vegetables, cheese and feta cheese, liver, and eggs in your diet;
• For diarrhea - avoid products containing essential oils (turnips, radishes, mushrooms);
• Eating tannin-rich foods (berries, pomegranates, persimmons).

Causes

Thus, malabsorption syndrome can be:

• primary, that is, congenital;
• secondary.

This type of disease is a consequence of genetic changes, which is why it is also called genetically determined enzymopathy. Moreover, it is often combined with celiac disease and cystic fibrosis.

Malabsorption is often observed with:

• congenital atrophy of microvilli;
• interstitial epithelial dysplasia;
• Shwachman-Diamond syndrome;
• malformations of the pancreas: ectopia (abnormal location);
• anular form (ring gland covering part of the duodenum);
• bifurcation;
• hypoplasia (underdevelopment).

Secondary disorders of absorption of substances in the small intestine occur during a person’s life against the background of the development of certain diseases, in particular:

• chronic gastritis with reduced secretory function;
• Crohn's disease;
• gluten enteropathy (celiac disease);
• acute bacterial or parasitic infection;
• chronic pancreatitis;
• thyrotoxicosis;
• liver cirrhosis;
• biliary obstruction (bile stagnation);
• mastocytosis;
• pancreatic cancer;
• small intestinal lymphoma;
• amyloidosis;
• Whipple's disease;
• enteropathy associated with metabolic defects or AIDS.

Malabsorption may occur after resection, that is, removal of part of the stomach and small intestine

Factors in the development of primary malabsorption syndrome:

• hereditary or congenital peptidase or disaccharidase deficiency syndrome;
• absence or insufficient production of the enterokinase enzyme;
• individual intolerance to monosaccharides;
• congenital celiac disease;
• cystic fibrosis;
• severe endocrine pathologies.

Primary processes cause the development of secondary, hereditary or congenital malabsorption and maldigestion syndrome. Secondary causes include the following factors:

• gastrogenic (result of gastric surgery, gastroesophageal reflux, malabsorption of fatty acids in the small intestine);
• hepatobiliary (various liver diseases, including hepatitis, cirrhosis, cholestasis, gallbladder pathologies);
• pancreatogenic (removal of part or total resection of the pancreas, pancreatitis);
• enterogenous (Crohn's disease, Whipple's disease, celiac disease, intestinal ischemia, parasites and viral diseases of the intestine, dysplasia or hyperplasia of the lining epithelium).

Diagnostics

The appearance of maldigestion syndrome can be suspected already at the initial examination after collecting an anamnesis and physical examination. In the syndrome, Obraztsov's symptom is positive (a stable rumbling is heard when palpating the cecum), Hertz's symptom (splashing when palpating the cecum), and pain occurs when palpating the Perges area. The purpose of diagnosis is not to confirm a disorder of digestive function, but to identify the cause that caused the pathology.

Digestive function can be studied by determining the activity of enzymes in intestinal juice and on the tissues of the intestinal tract, as well as blood tests for the concentration of monomers, since with maldigestion syndrome the amount of amino acids and monosaccharides increases.

Cavitary digestion depends on the activity of pancreatic enzymes (alpha-amylase, alkaline phosphatase, enterokinase); the rate of parietal digestion is influenced by intestinal enzymes (peptidases, disaccharidases). Their quantity in the intestine is determined during the study of the homogenate and washout from the small intestine.

How active the enterocyte enzymes are is assessed by studying the glycemic curve, the results of which depend on the load of disaccharides (the patient is given sucrose, lactose, maltose to drink and after a quarter of an hour, half an hour and an hour the blood glucose level is checked). It is possible to determine the state of the digestive system through a scatological examination.

Maldigestion syndrome provokes an increase in excreted feces, an increased content of myocytes (muscle fibers), starch, and fat droplets. Patients develop steatorrhea (the stool is greasy, shiny, and difficult to wash off); to determine its degree, the stool is examined using the Van de Kamer method. A bacteriological examination of stool is required to determine the degree of dysbiosis and the type of microbes that populate the intestines.

The degree of changes in the structure of the tissue of the small intestine (atrophy, dystrophy, height and number of villi, areas of necrosis, impaired blood supply) allows us to evaluate endoscopic examination of the small intestine. The level of organ damage is determined using contrast-enhanced X-rays.

Classification

Scientists divide maldigestion syndrome into two forms:

• congenital;
• acquired.

Congenital diseases can be caused by celiac enteropathy, which is accompanied by damage to the intestinal villi and a lack of disaccharidases - intestinal enzymes that process disaccharides. The syndrome may also be caused by an insufficient amount of enterokinase, an enzyme in intestinal juice that produces the enzyme trypsin by converting trypsinogen.

However, some use a different classification, which reflects a disorder at a certain stage of digestion:

• cavity;
• parietal maldigestion;
• intracellular maldigestion.

According to the International Classification of Diseases ICD-10, pathology of this kind is assigned the code K90.

Establishing diagnosis

Such a complex disorder requires a complete diagnosis of the patient, so several examination methods are used:

1. Blood test:
   biochemical analysis - low levels of protein and calcium are detected;
2. general analysis - anemia is detected;
3. identifying the level of coagulation - helps to detect vitamin K deficiency;
4. determination of the content of substances in the blood: sodium, calcium, electrolytes, vitamin B12 and iron.
5. Additional research:
   stool analysis - unabsorbed elements are detected in the patient’s stool, the level of fatty acids is increased;
6. determination of autoantibodies - necessary for the development of celiac disease;
7. Diagnosis of the secretory function of the pancreas.
8. Test samples:
   breath test with xylose - detects the growth of pathogenic microflora;
9. Schilling test - assess the degree of malabsorption of vitamin B12;
10. pancreolauryl and stimulated secretin test - study pancreatic insufficiency;

Blood tests help identify nutritional deficiencies

To confirm pathology and differential diagnosis, instrumental research methods are used:

• biopsy of the intestinal mucosa - reveals the disease or tumor that caused the disorder;
• magnetic resonance and computed tomography;
• endoscopy of the duodenum and colon, as well as the stomach and esophagus - detect diseases and other causes of the syndrome;
• ultrasound examination of the abdominal cavity;
• X-ray diagnostics - detect anatomical changes indicating bacterial growth.

Differential diagnosis: maldigestion, malassimilation - table

Where to go for help

If you feel any health problems and feel the above-mentioned symptoms of maldigestion, you should immediately contact a hospital or private clinic, a pediatrician (general practitioner) or a gastroenterologist. After passing the necessary tests and examinations, the doctor will prescribe you treatment.

One of the reasons for the occurrence of maldigestion in women, against the background of existing pancreatitis, is “starvation diets”. Representatives of the fair sex, in pursuit of an ideal figure, personally worsen their health.

If your financial situation allows you to be examined abroad, Germany and Israel, with their advanced technologies and methods, are possible options for you.

ATTENTION! To avoid deterioration of your health, do not put off going to the hospital, hoping for a cure with folk remedies. Self-medication can worsen your condition!

Main provoking factors and concomitant diseases

According to etiology, the syndrome is divided into 2 main groups:

1. Primary (congenital),
2. Secondary (developed against the background of gastrointestinal pathologies).

The congenital group of digestive insufficiency is caused by enzymatic pathologies:

1. Disaccharidase deficiency, leading to intolerance to substances containing disaccharidase enzymes. Detection of pathology is especially important for children on breast milk, since one of the manifestations of the disorder is lactase deficiency, leading to the indigestibility of dairy products.
2. Celiac disease (peptidase deficiency) is a congenital pathology that disrupts the digestibility of certain protein groups, causing diarrhea and chronic steatorrhea.
3. Enterokinase deficiency.

The acquired group is accompanied by the following enzymatic pathologies:

1. Elementary, provoked by dietary disorders.
2. Pathologies of the gastrointestinal tract (including functional ones).
3. Consequences of surgery.
4. Pathologies of the endocrine glands.
5. Age-related changes.

It is interesting that for a long time, a significant increase in patients with chronic pancreatitis with concomitant maldigestion has been caused by a widespread craze for starvation diets. The so-called glossy image of a slender beauty makes women go hungry or refuse to eat. And in this pursuit of an ephemeral ideal, people forget about their own health.

For example, let's take an enzyme such as lipase, which is actively involved in the breakdown of fatty acids and subsequent absorption of fats. Among the organs of the digestive tract, not a single one is capable of synthesizing an element that at least partially recreates the activity of lipase.

When, due to pancreatitis, part of the secretion cells dies, an enzyme deficiency for fat processing occurs. All this is expressed in extreme discomfort when consuming fatty foods, even in the smallest quantities.

Diseases that are accompanied by pathology:

• endocrine pathologies: diabetes type 1, type 2, thyroid disorders;
• cirrhosis and hepatitis of the liver, diseases of the biliary tract;
• chronic enteritis;
• inflammation, stones, malignant neoplasms, fistulas in the pancreas;
• cystic fibrosis;
• gastroduodenitis, duodenal ulcer;
• dysbiosis of the small intestine;
• obstruction of the intestinal lymph ducts;
• concomitant disorders with AIDS, giardiasis, hyperthyroidism.

Causes of maldigestion syndrome

The factors that provoke the occurrence of maldigestion are extremely diverse: this explains the high prevalence of the pathology in patients of any age.

Maldigestion syndrome is usually divided into three forms, represented by pathologies of intracellular, cavity and parietal digestion.

The cause of abdominal digestion disorders can be:

• Insufficient production of pancreatic juice rich in alkali and digestive enzymes (called exocrine pancreatic insufficiency), observed in certain diseases of the pancreas, such as cystic fibrosis, chronic pancreatitis, fistulas or cancer of this organ, as well as after surgical removal of segments of the pancreas as a result of subtotal pancreatectomy.
• Inactivation (partial or complete loss of activity) of digestive enzymes that occurs in the body of patients suffering from duodenal ulcer, Zollinger-Ellison syndrome, gastroduodenitis and dysbiosis (pathological change in the qualitative composition of the intestinal microflora) of the small intestine.
• Mixing of digestive enzymes with chyme and impaired transit of intestinal contents, observed in patients with diarrhea, irritable bowel syndrome, chronic intestinal pseudo-obstruction, stenosis of various parts of the intestine, as well as in conditions arising after drainage surgical interventions and gastric vagotomy.
• A significant decrease in the concentration of digestive enzymes (due to their “dilution”), characteristic of dysbiosis of the small intestine, post-gastroectomy syndrome and a condition provoked by cholecystectomy (removal of the gallbladder).
• Decreased synthesis of the peptide hormone secretin and the neuropeptide hormone cholecystokinin, produced by special cells of the mucous membrane of the small intestine.
• Acute lack of bile acids, provoked by liver pathologies (primary biliary cirrhosis, biliary obstruction, hepatitis), diseases of the terminal small intestine, dysbiosis of the small intestine, as well as therapy with cholestyramine.
• Gastrogenic digestive insufficiency, developing in patients with atrophic gastritis or after surgery consisting of removal (resection) of part of the stomach.
• Since enterocytes - intestinal epithelial cells - are responsible for the success of parietal (membrane) digestion, their death or degeneration caused by gluten enteropathy, Crohn's disease, enteritis of various etiologies and sarcoidosis can cause dysfunctional conditions of the gastrointestinal tract.
• The culprit of intracellular digestion disorders is most often an acute deficiency of disaccharidases (enzymes secreted by the cells of the intestinal mucosa), caused by enzymatic deficiency, which is primary (congenital) or secondary (acquired) in nature.
• Digestive disorders may be caused by improper drainage of lymphatic fluid from the intestines due to obstruction of the lymphatic ducts. Similar pathologies are observed in patients suffering from lymphomas, intestinal tuberculosis, lymphangiectasia, and intestinal carcinoid (carcinoid tumor).
• Maldigestion can be triggered by a whole complex of disorders that accompany AIDS, hypogammaglobulinemia (a pathology caused by a deficiency of B cells against the background of a decrease in the size of immunoglobulins), hyperthyroidism (a condition caused by too active synthesis of thyroid hormones by the thyroid gland), diabetes mellitus, amyloidosis (a disorder of protein metabolism, leading to the deposition of protein-polysaccharide substances - amyloids - in tissues), giardiasis and many other diseases.
• Maldigestion can be triggered by the abuse of fermented drinks (homemade wine, all types of kvass), as well as poor nutrition and excessive dieting.

As a rule, it is provoked by a confluence of factors that prevent a sufficient or even slightly increased amount of digestive enzymes from being activated or properly contacting the substrate.

Etiology

The syndrome can accompany a person from birth, however, it can be triggered by certain factors, for example:

• improper diet;
• infections in the intestines;
• excessive consumption of fermented drinks (kvass, beer, homemade wine);
• taking antibacterial drugs or cytostatics for a long time.

Various diseases can also provoke such a pathological process, such as:

• hyperthyroidism;
• carcinoid tumor;
• sarcoidosis;
• amyloidosis;
• gastritis;
• dysbacteriosis;
• dysfunction of bile secretion;
• duodenal ulcer;
• pancreas cancer;
• AIDS;
• hypogammaglobulinemia;
• lymphangiectasia;
• intestinal tuberculosis;
• chronic pancreatitis;
• Crohn's disease;
• disorders of the thyroid gland.

Crohn's disease

Recently, the number of patients diagnosed with pancreatitis with accompanying maldigestion syndrome, provoked by strict diets, has increased significantly.

What is malabsorption and maldigestion syndrome: symptoms and treatment

Digestion is a process carried out by the stomach and intestines, which consists of converting complex biochemical compounds into simpler ones. At each stage, many functional actions of the gastrointestinal tract occur, and a change in any of them leads to disorders of varying severity.

With malabsorption and maldigestion syndromes, a persistent disruption of any stage in the digestive system occurs. The disease can be caused by various diseases or be their consequence. What is it and can the pathology be cured?

Diagnostic features

Diagnostics is the field of activity of gastroenterologists. The diagnosis is based on medical history, patient complaints and other studies:

• palpation of the peritoneum and physical examination of the patient;
• coprogram (qualitative composition of feces);
• stool bacteriology;
• blood and urine tests as differential diagnostics (biochemistry, bacterial culture, qualitative and quantitative composition);
• tests for the concentration of stomach and intestinal enzymes;
• X-ray of the peritoneal organs with contrast;
• Ultrasound of the pelvis, liver, kidneys, abdominal organs.

Reference. An important diagnostic method is fibrogastroduodenoscopy. This is an endoscopic research method that allows you to assess the condition of the lining of the digestive tract, perform a biopsy, and, if necessary, therapeutic manipulations.

Treatment methods

Treatment of maldigestion and malabsorption syndrome is always comprehensive, aimed at replenishing vitamins, proteins, mineral composition, and normalizing intestinal absorption.

Traditional medicine

The medication regimen includes the following medications:

• digestive enzymes;
• means for normalizing the composition of bile;
• hepatoprotectors;
• antibiotics for infectious and inflammatory processes;
• intestinal antiseptics;
• anti-diarrhea medications, laxatives for constipation.

It is useful to take vitamin complexes, absorbents along with pro- and prebiotics to normalize the intestinal microflora.

Traditional methods of treatment are not used, but can sometimes provide relief from constipation or diarrhea.

Prognosis and prevention

The prognosis for timely treatment of malabsorption and maldigestion syndrome is favorable only if the rules of food discipline and medical recommendations are followed. An unfavorable prognosis is possible when complications arise and the rapid development of organ failure.

Note! There is no specific prevention of the syndrome, however, timely treatment of viral and parasitic intestinal pathologies and maintaining a healthy lifestyle significantly reduce the risks of secondary intestinal malabsorption

Possible complications

Impaired absorption in the gastrointestinal tract can be complicated by:

• iron deficiency anemia, hypoxia;
• cycle disorders in women, amenorrhea;
• deformation of bone tissue;
• worsening weight gain in children;
• reduction in body weight to critical values.

Chronic symptoms can lead to mental disorders due to constant discomfort in the gastrointestinal tract. In complex cases, the disease can contribute to the development of cancer or liver failure.

Conclusion

The syndrome of malabsorption and maldigestion is often underestimated, especially in the early stages of development. With persistent digestive disorders, severe functional disorders develop in the gastrointestinal tract, which are subsequently difficult to treat and complicate the prognosis.

The information on our website is provided by qualified doctors and is for informational purposes only. Don't self-medicate! Be sure to consult a specialist!

Rumyantsev V. G. Experience 34 years.

Gastroenterologist, professor, doctor of medical sciences. Prescribes diagnostics and carries out treatment. Expert of the group for the study of inflammatory diseases. Author of more than 300 scientific papers.

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Tips for parents

To avoid maldigestion syndrome, parents should carefully monitor the child’s diet and lifestyle. From an early age, he needs to be taught proper nutrition on an ongoing basis. The child's menu should consist exclusively of natural products, steamed, boiled or baked . You should explain to your child why you should not eat newfangled sweets and snacks, and what the consequences may be.

If a child complains of pain or discomfort in the abdomen, in no case should you ignore it, hoping that everything will go away on its own. It is necessary to immediately consult a pediatrician to determine the cause of the pain. You should not self-medicate, as you can harm the child with your own hands.

What is the danger of maldigestion, preventive measures

The danger of digestive insufficiency lies not so much in poor general health, but in the stimulation of the pathoprocesses of the underlying disease.

Thus, with the progression of chronic pancreatitis with concomitant fermentopathy, signs of endocrine system disorders and the development of diabetes mellitus are observed.

The most effective measures to prevent the occurrence of digestive insufficiency syndrome are extremely simple and understandable to everyone:

• balanced diet;
• compliance with hygiene standards;
• visiting a doctor to monitor the condition of the gastrointestinal tract;
• timely diagnosis and treatment of pathologies of the digestive system.