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Advances in Nutrition (Bethesda, Md.) Sep 2013Moderate/severe obesity is on the rise in the United States. Weight management includes bariatric surgery, which is effective and can alleviate morbidity and mortality... (Review)
Review
Moderate/severe obesity is on the rise in the United States. Weight management includes bariatric surgery, which is effective and can alleviate morbidity and mortality from obesity-associated diseases. However, many individuals are dealing with nutritional complications. Risk factors include: 1) preoperative malnutrition (e.g., vitamin D, iron); 2) decreased food intake (due to reduced hunger and increased satiety, food intolerances, frequent vomiting); 3) inadequate nutrient supplementation (due to poor compliance with multivitamin/multimineral regimen, insufficient amounts of vitamins and/or minerals in supplements); 4) nutrient malabsorption; and 5) inadequate nutritional support (due to lack of follow-up, insufficient monitoring, difficulty in recognizing symptoms of deficiency). For some nutrients (e.g., protein, vitamin B-12, vitamin D), malnutrition issues are reasonably addressed through patient education, routine monitoring, and effective treatment strategies. However, there is little attention paid to other nutrients (e.g., zinc, copper), which if left untreated may have devastating consequences (e.g., hair loss, poor immunity, anemia, defects in neuro-muscular function). This review focuses on malnutrition in essential minerals, including calcium (and vitamin D), iron, zinc, and copper, which commonly occur following popular bariatric procedures. There will be emphasis on the complexities, including confounding factors, related to screening, recognition of symptoms, and, when available, current recommendations for treatment. There is an exceptionally high risk of malnutrition in adolescents and pregnant women and their fetuses, who may be vulnerable to problems in growth and development. More research is required to inform evidence-based recommendations for improving nutritional status following bariatric surgery and optimizing weight loss, metabolic, and nutritional outcomes.
Topics: Bariatric Surgery; Calcium; Copper; Deficiency Diseases; Humans; Intestinal Absorption; Iron; Iron Deficiencies; Malabsorption Syndromes; Minerals; Vitamin D Deficiency; Zinc
PubMed: 24038242
DOI: 10.3945/an.113.004341 -
Clinical Radiology Feb 1992
Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Barium Sulfate; Celiac Disease; Cystic Fibrosis; Enema; Humans; Malabsorption Syndromes; Male; Radiography; Short Bowel Syndrome; Whipple Disease; Zollinger-Ellison Syndrome
PubMed: 1371095
DOI: 10.1016/s0009-9260(05)80058-3 -
Food and Nutrition Bulletin Mar 2015Environmental enteric dysfunction (EED) refers to an incompletely defined syndrome of inflammation, reduced absorptive capacity, and reduced barrier function in the... (Review)
Review
BACKGROUND
Environmental enteric dysfunction (EED) refers to an incompletely defined syndrome of inflammation, reduced absorptive capacity, and reduced barrier function in the small intestine. It is widespread among children and adults in low- and middle-income countries. Understanding of EED and its possible consequences for health is currently limited.
OBJECTIVE
A narrative review of the current understanding of EED: epidemiology, pathogenesis, therapies, and relevance to child health.
METHODS
Searches for key papers and ongoing trials were conducted using PUBMED 1966-June 2014; ClinicalTrials.gov; the WHO Clinical Trials Registry; the Cochrane Library; hand searches of the references of retrieved literature; discussions with experts; and personal experience from the field.
RESULTS
EED is established during infancy and is associated with poor sanitation, certain gut infections, and micronutrient deficiencies. Helicobacter pylori infection, small intestinal bacterial overgrowth (SIBO), abnormal gut microbiota, undernutrition, and toxins may all play a role. EED is usually asymptomatic, but it is important due to its association with stunting. Diagnosis is frequently by the dual sugar absorption test, although other biomarkers are emerging. EED may partly explain the reduced efficacy of oral vaccines in low- and middle-income countries and the increased risk of serious infection seen in children with undernutrition.
CONCLUSIONS
Despite its potentially significant impacts, it is currently unclear exactly what causes EED and how it can be treated or prevented. Ongoing trials involve nutritional supplements, water and sanitation interventions, and immunomodulators. Further research is needed to better understand this condition, which is of likely crucial importance for child health and development in low- and middle-income settings.
Topics: Adult; Bacterial Infections; Blind Loop Syndrome; Child, Preschool; Environment; Growth Disorders; Humans; Infant; Inflammation; Intestinal Diseases; Intestines; Malabsorption Syndromes; Poverty; Sanitation
PubMed: 25902619
DOI: 10.1177/15648265150361S113 -
International Journal of Clinical... Feb 2018In exocrine pancreatic insufficiency (EPI), the quantity and/or activity of pancreatic digestive enzymes are below the levels required for normal digestion, leading to... (Review)
Review
AIMS
In exocrine pancreatic insufficiency (EPI), the quantity and/or activity of pancreatic digestive enzymes are below the levels required for normal digestion, leading to maldigestion and malabsorption. Diagnosis of EPI is often challenging because the characteristic signs and symptoms overlap with those of other gastrointestinal conditions. Additionally, there is no single convenient, or specific diagnostic test for EPI. The aim of this review is to provide a framework for differential diagnosis of EPI vs other malabsorptive conditions.
METHODS
This is a non-systematic narrative review summarising information pertaining to the aetiology, diagnosis and management of EPI.
RESULTS
Exocrine pancreatic insufficiency may be caused by pancreatic disorders, including chronic pancreatitis, cystic fibrosis, pancreatic resection and pancreatic cancer. EPI may also result from extra-pancreatic conditions, including coeliac disease, Zollinger-Ellison syndrome and gastric surgery. Timely and accurate diagnosis of EPI is important, as delays in treatment prolong maldigestion and malabsorption, with potentially serious consequences for malnutrition, overall health and quality of life. Symptoms of EPI are non-specific; therefore, a high index of clinical suspicion is required to make a correct diagnosis.
Topics: Diagnosis, Differential; Exocrine Pancreatic Insufficiency; Humans; Malabsorption Syndromes; Quality of Life
PubMed: 29405509
DOI: 10.1111/ijcp.13066 -
Current Gastroenterology Reports Jun 2023Disaccharidase deficiency in adults causes carbohydrate malabsorption, resulting in symptoms which significantly overlap with irritable bowel syndrome (IBS). This... (Review)
Review
PURPOSE OF REVIEW
Disaccharidase deficiency in adults causes carbohydrate malabsorption, resulting in symptoms which significantly overlap with irritable bowel syndrome (IBS). This article discusses the diagnosis and treatment of disaccharidase deficiency within the context of recent literature.
RECENT FINDINGS
Disaccharidase deficiency in adults is more common than previously thought, which includes lactase, sucrase, maltase and isomaltase enzymes. Deficiency in disaccharidases, which are produced by the intestinal brush border, will interfere with the breakdown and absorption of carbohydrates and may result in abdominal pain, gas, bloating and diarrhea. Patients deficient in all 4 disaccharidases are known as having "pan-disaccharidase" deficiency, which has a distinct phenotype with more reported weight loss than patients deficient in one enzyme. IBS patients who do not respond to low FODMAP dietary restriction may have undiagnosed disaccharidase deficiency and may benefit from testing. Diagnostic testing methods are limited to duodenal biopsies, which is the gold standard, and breath testing. Dietary restriction and enzyme replacement therapy have been shown to be effective treatments in these patients. Disaccharidase deficiency is an underdiagnosed condition in adults with chronic GI symptoms. Patients who do not respond to traditional treatment strategies for DBGI may benefit from testing for disaccharidase deficiency. Further studies delineating the distinctions between disaccharidase deficient patients and those with other motility disorders are needed.
Topics: Humans; Irritable Bowel Syndrome; Malabsorption Syndromes; Disaccharidases; Sucrase; Diarrhea
PubMed: 37199899
DOI: 10.1007/s11894-023-00870-z -
Histopathology Jan 2007Intestinal malabsorption results from a wide variety of causes, which can most easily be organized into three groups. Maldigestion arises from problems with mixing or... (Review)
Review
Intestinal malabsorption results from a wide variety of causes, which can most easily be organized into three groups. Maldigestion arises from problems with mixing or with digestive mediators, and includes post-gastrectomy patients and those with deficiencies of pancreatic or intestinal enzymes, or of bile salts. Mucosal and mural causes of malabsorption are abundant, and include gluten-sensitive enteropathy, tropical sprue, autoimmune enteropathy, and HIV/AIDS-related enteropathy, as well as mural conditions such as systemic sclerosis. Finally, microbial causes of malabsorption include bacterial overgrowth, Whipple's disease, and numerous infections or infestations that are most frequently seen in immunocompromised patients. An overview of the most common and interesting entities in each of these categories follows, along with a discussion of current concepts. Mucosal conditions and microbial causes of malabsorption are given special attention.
Topics: Humans; Intestinal Absorption; Intestinal Mucosa; Malabsorption Syndromes
PubMed: 17204022
DOI: 10.1111/j.1365-2559.2006.02547.x -
Acta Medica Indonesiana Apr 2013Chronic diarrhea is defined as the passage of loose stools that last for more than 4 weeks. Although generally it is estimated that the prevalence of chronic diarrhea... (Review)
Review
Chronic diarrhea is defined as the passage of loose stools that last for more than 4 weeks. Although generally it is estimated that the prevalence of chronic diarrhea only ranges 3-5% of population, but it poses some specific equally essential challenges compared to acute diarrhea because there are many differential diagnosis that should be considered as the cause of chronic diarrhea. One of them includes colorectal cancer and the small intestinal bacterial overgrowth, known as SIBO. In general, chronic diarrhea can be categorized into watery, malabsorption, and inflammatory diarrhea. A proper history taking, physical examination and laboratory investigation is therefore necessary for clinician in managing chronic diarrhea. Overall, the management of chronic diarrhea includes two types, i.e. supportive and pharmacological management both for infectious and non-infectious etiologies. Pharmacological treatment can also be classified into two kinds of treatment including symptomatic and causal treatment, which can be achieved through empirical therapy.
Topics: Chronic Disease; Colorectal Neoplasms; Diagnosis, Differential; Diarrhea; Humans; Indonesia; Inflammatory Bowel Diseases; Intestinal Diseases; Malabsorption Syndromes; Medical History Taking; Physical Examination; United States
PubMed: 23770798
DOI: No ID Found -
Gut Nov 1989The small intestine plays a key role in lipid metabolism by absorbing fat and synthesising apoproteins. Fat malabsorption secondary to intestinal disease results in... (Review)
Review
The small intestine plays a key role in lipid metabolism by absorbing fat and synthesising apoproteins. Fat malabsorption secondary to intestinal disease results in abnormalities of lipoprotein concentration and composition and can lead to deficiency of essential fatty acids and fat-soluble vitamins. Malabsorption of fat can be induced by administration of neomycin and malabsorption of bile acids by administration of anion-exchange resins or by creating a partial ileal bypass. These induced forms of malabsorption are useful in the treatment of hyperlipidaemic patients liable to atherosclerosis.
Topics: Animals; Dietary Fats; Humans; Lipid Metabolism; Malabsorption Syndromes
PubMed: 2691346
DOI: 10.1136/gut.30.spec_no.29 -
Annals of Nutrition & Metabolism 2016Childhood functional gastrointestinal disorders (FGIDs) affect a large number of children throughout the world. Carbohydrates (which provide the majority of calories... (Review)
Review
Childhood functional gastrointestinal disorders (FGIDs) affect a large number of children throughout the world. Carbohydrates (which provide the majority of calories consumed in the Western diet) have been implicated both as culprits for the etiology of symptoms and as potential therapeutic agents (e.g., fiber) in childhood FGIDs. In this review, we detail how carbohydrate malabsorption may cause gastrointestinal symptoms (e.g., bloating) via the physiologic effects of both increased osmotic activity and increased gas production from bacterial fermentation. Several factors may play a role, including: (1) the amount of carbohydrate ingested; (2) whether ingestion is accompanied by a meal or other food; (3) the rate of gastric emptying (how quickly the meal enters the small intestine); (4) small intestinal transit time (the time it takes for a meal to enter the large intestine after first entering the small intestine); (5) whether the meal contains bacteria with enzymes capable of breaking down the carbohydrate; (6) colonic bacterial adaptation to one's diet, and (7) host factors such as the presence or absence of visceral hypersensitivity. By detailing controlled and uncontrolled trials, we describe how there is a general lack of strong evidence supporting restriction of individual carbohydrates (e.g., lactose, fructose) for childhood FGIDs. We review emerging evidence suggesting that a more comprehensive restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) may be effective. Finally, we review how soluble fiber (a complex carbohydrate) supplementation via randomized controlled intervention trials in childhood functional gastrointestinal disorders has demonstrated efficacy.
Topics: Abdominal Pain; Child; Child Nutritional Physiological Phenomena; Diet, Carbohydrate-Restricted; Dietary Carbohydrates; Dietary Fiber; Dietary Supplements; Evidence-Based Medicine; Fermentation; Food Intolerance; Gastrointestinal Diseases; Gastrointestinal Microbiome; Humans; Malabsorption Syndromes; Precision Medicine
PubMed: 27355647
DOI: 10.1159/000445390 -
British Medical Journal Mar 1978
Topics: Folic Acid Deficiency; Humans; Ileum; Jejunum; Malabsorption Syndromes; Postoperative Complications
PubMed: 630322
DOI: No ID Found