Gastrointestinal disease malabsorption

Common medical conditions in the elderly such as gastrointestinal disease, malabsorption syndromes and acute and chronic infections often cause a loss of appetite. Another common problem is ill-fitting dentures. All these situations need to be addressed to promote adequate nutrition. 

Thyroid disorders (hypothyroidism or hyperthyroidism) Cardiovascular disease (arrhythmias, congestive heart failure) Gastrointestinal disease or disorder (sprue or other malabsorption syndromes, peptic ulcer, cohtis)... 

Figure 48-4 Summary of the processes involved in fat absorption and malabsorption. (From Clark ML, Silk DB. Gastrointestinal disease. In Kumar P, Clark M, eds. Clinical medicine, 5th ed. Edinburgh WB Saunders, 2002 253-333.)...

Sprue. Folic acid is effective in the treatment of sprue, a gastrointestinal disease characterized by intestinal lesions, malabsorption of food, diarrhea, stools containing large amounts of fat, macrocytic anemia, and general malnutrition. 

Vitamin A deficiency is worldwide one of the most prevalent nutrition-dependent deficiency diseases. It leads to changes of the respiratory epithelium, which result in repeated infections of the respiratory tract, the main cause of death in vitamin A-deficient children. The difficulty in supplying the respiratory epithelium with vitamin A is that the affected children frequently suffer as well from infections of the gastrointestinal tract with subsequent reduction of the absorption of fat-soluble vitamins. Nutritargeting can in these cases avoid the problems of malabsorption and ensure the micronutrient supply. 

Malabsorption resulting from various gastrointestinal conditions (e.g., Crohn s disease)... 

A number of gastrointestinal and hepatic diseases result in disordered calcium and phosphate homeostasis that ultimately leads to bone disease. The bones in such patients show a combination of osteoporosis and osteomalacia. Osteitis fibrosa does not occur (as it does in renal osteodystrophy). The common features that appear to be important in this group of diseases are malabsorption of calcium and vitamin D. Liver disease may, in addition, reduce the production of 25(OH)D from vitamin D, though the importance of this in all but patients with terminal liver failure remains in dispute. The malabsorption of vitamin D is probably not limited to exogenous vitamin D. The liver secretes into bile a substantial number of vitamin D metabolites and conjugates that are reabsorbed in (presumably) the distal jejunum and ileum. Interference with this process could deplete the body of endogenous vitamin D metabolites as well as limit absorption of dietary vitamin D. 

Celiac disease is the result of the development of inflammatory-allergic condition due to gluten intolerance. The disease occurs both in adults and in children in a number of countries all over the world. Its occurrence is fairly frequent, it is estimated that approximately 1% of the population suffers from it. Patients manifest not only gastrointestinal symptoms, but also symptoms which are the consequence of malabsorption syndrome, such as osteoporosis, hypochromic anemia, hypoproteinaemia, hypocalcemia, short stature in children, vitamin deficiency, secondary polysensibilization, and emotional disturbances. Moreover, it has been observed that the occurrence of autoimmunological diseases and neoplasms in patients who are not treated with gluten-free diet doubles (Swinson et al., 1983 Ventura et al., 1999). 

In ABL, fat malabsorption is responsible for the diarrhea and flatus. Symptoms are prominent in affected newborns with the severity coupled to their lipid-rich diets. Chronic diarrhea results in nutrient wasting and, in some cases, failure to thrive. Since fat malabsorption is responsible for the initial gastrointestinal symptoms, it is not uncommon for affected individuals to restrict dietary fat independent of medical advice, alleviating the frequency of diarrhea and flatus. Occasional exacerbations still occur, but not serious enough to provoke a clinical visit. As a result, affected individuals often develop normally, unaware of their disease, until a gross secondary neuropathy becomes symptomatic toward the third decade of life or even earlier. 

Abnormalities of the gastrointestinal tract in which the proportion of dietary iron absorbed may be reduced, i.e. in malabsorption syndromes such as coeUac disease. 

The stomach, intestinal tract, and pancreas are closely related, both anatomically and fnnctionaily, and symptoms, such as diarrhea or malabsorption, may be associated with diseases or disorders of any of these organs. It is therefore appropriate to discuss them together. Advances in imaging techniques and unprovements in endoscopic procedures have led to enormous changes in the investigation of gastrointestinal (GI) and pancreatic function so that many laboratory tests, once considered important, have now been superseded. 

A variety of symptoms can arise from Gl dysfunction. Common Gl symptoms include heartburn, abdominal pain, dyspepsia, nausea, vomiting, diarrhea, constipation, and gastrointestinal bleeding. Signs and symptoms of malabsorption, hepatitis, and Gl infection are also commonly seen. The next sections describe methods that are commonly used to assess patients with Gl complaints. For specific details concerning each Gl disease state, please consult that particular chapter in this book. 

Gastrointestinal disorders (gastrectomy, malabsorption syndromes, inflammatory bowel disease, sprue)... 

Malnutrition has been reported in 20% to 45% of patients with inflammatory bowel disease (IBD). Malabsorption, increased gastrointestinal losses, or poor oral intake are the predominant causes. " Decreased food intake may be due to pain, anorexia, or altered taste malabsorption may be due to mucosal abnormalities, bacterial overgrowth, or diminished absorptive surface area after surgical resection of diseased bowel, and hypermetabolism may be a consequence of fever and infection. Various nutrient abnormalities, such as anemia... 

An intact functional GIT is essential for complete absorption and digestion of nutrients. Short bowel syndrome (SBS) is a disease state imposed by significant resection of the small bowel, which results in the malabsorption of nutrients and fluids. Morbidity and mortality due to gastrointestinal failure in SBS patients has been improved by interventional nutrition with PN and EN. The goal of nutritional... 

Hartnup disease is an inherited autosomal recessive disease that manifests itself in malabsorption of neutral amino acids, including tryptophan, in the gastrointestinal tract and also in deficient reabsorption of these amino acids in the renal tubules. The deficient uptake of tryptophan can result in a pellagra-like condition, which may include mental manifestations such as... 

Malabsorption of calcium is often the consequence of hypovitaminosis D, which is observed in gastrointestinal, hepatic, and renal diseases (Haussler et al. 1976, Fraser 1980, Iqbal 1994), as well as in some endocrine disorders such as hyperthyroidism (Peerenboom et al. 1984). Alcoholism (Kra-witt 1975) and long-term treatment with certain drugs, particularly glucocorticoids (Klein et al. 1977) or anti-convulsants (Hahn and Halstead 1979), also have negative effects on calcium absorption from the intestine. 

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