Malabsorption

What is Malabsorption?

Malabsorption is an over-arching term in Singapore for a number of conditions that result in the inadequate absorption of nutrients from food.

Our gastrointestinal tract, which comprise the mouth, oesophagus, stomach, small intestine, large intestine, rectum, and anus, is responsible for the three stages of digestion:

Stage 1: mechanical breaking down of food into smaller pieces which takes place in our mouth
Stage 2: absorption of nutrients from the food we consume
Stage 3: removal of waste products from the body

Malabsorption occurs when we have difficulties with stage 2 of the digestive process, when our small intestine is unable to absorb certain nutrients and fluids. This involves a number of gastrointestinal diseases and food intolerances that prevent or restrict the small intestines from absorbing certain nutrients; as such there are different types of malabsorption, these are:

Fat malabsorption: this occurs when the small intestine is unable to absorb fats from the food you eat. These fats then pass through the large intestine and get excreted. Fatty stools usually float, are runny, and are very smelly. They will also be light-coloured.
Carbohydrate malabsorption: individuals may experience sensitivity to one or more carbohydrates. The unabsorbed carbohydrates get fermented by the bacteria present in the stomach, this causes gassiness and fatty stools.

Bile acid malabsorption: when there is unabsorbed bile acid in the stomach, it gets passed through the small intestine and into the large intestine. The bile acid will then trigger your colon to secrete water, which in the end results in diarrhoea.
Protein malabsorption: occurs as a result of food intolerance, this can be seen commonly in milk and gluten intolerance.
Fructose malabsorption: this occurs when the small intestine is unable to absorb fructose which is a simple sugar present in fruits and some vegetables.

What causes malabsorption?

Malabsorption is caused by a plethora of issues such as diseases and infections, it can also be something that you are just born with. Some of these causes include:

Damage to the lining of your small intestine: damage due to surgery, injury, infections, or inflammation.
Lactose intolerance: inability to absorb lactose which is present in dairy.
Parasites: diseases caused by parasites can damage the small intestine.
Medical conditions: coeliac disease, Crohn’s disease, chronic pancreatitis, cystic fibrosis.
Congenital issues: conditions (e.g., biliary atresia) that you are born with can lead to malabsorption.
Digestive problems: your stomach is a muscle that has two functions. Producing enzymes required for digestion and mixing the food together with the enzymes. Either one or both may be malfunctioning.
Excessive use of certain medications: prolonged use of certain medications such as antibiotics may cause injury to the small intestine.
Tropical sprue: common in certain areas of the world like India, the Caribbean, and parts of Southeast Asia. It can be found in contaminated food, infections, and parasites.
Whipple’s disease: a type of bacterial infection that occurs in the gastrointestinal tract but can spread to other organs.
Short bowel syndrome (SBS): this means that the small intestine is shorter than normal, which results in less surface area for absorption to take place. It can be an acquired condition (where the small intestine is shortened during surgery) or congenital (something that you were born with).

What causes Malabsorption?

Malabsorption is caused by a plethora of issues such as diseases and infections, it can also be something that you are just born with. Some of these causes include:

Damage to the lining of your small intestine: damage due to surgery, injury, infections, or inflammation.
Lactose intolerance: inability to absorb lactose which is present in dairy.
Parasites: diseases caused by parasites can damage the small intestine.
Medical conditions: coeliac disease, Crohn’s disease, chronic pancreatitis, cystic fibrosis.
Congenital issues: conditions (e.g., biliary atresia) that you are born with can lead to malabsorption.
Digestive problems: your stomach is a muscle that has two functions. Producing enzymes required for digestion and mixing the food together with the enzymes. Either one or both may be malfunctioning.
Excessive use of certain medications: prolonged use of certain medications such as antibiotics may cause injury to the small intestine.
Tropical sprue: common in certain areas of the world like India, the Caribbean, and parts of Southeast Asia. It can be found in contaminated food, infections, and parasites.
Whipple’s disease: a type of bacterial infection that occurs in the gastrointestinal tract but can spread to other organs.
Short bowel syndrome (SBS): this means that the small intestine is shorter than normal, which results in less surface area for absorption to take place. It can be an acquired condition (where the small intestine is shortened during surgery) or congenital (something that you were born with).

What are the common symptoms of Malabsorption in Singapore?

There are many stages of malabsorption, so symptoms in the early stages of malabsorption are different from those in the later stages. Symptoms will also differ based on the type of nutrients that cannot be absorbed.

Symptoms in the early stages of malabsorption:

Abdominal pain
Bloating
Nausea and vomiting
Fatty stools
Diarrhoea
Gassiness

Symptoms in the late stages of malabsorption:

Unexplained weight loss
Dry skin and skin lesions
Getting bruised easily
Dry hair and hair loss
Muscle loss
Dehydration
Getting infections frequently
Night blindness
Fragile bones
Nose bleeds and bleeding gums
General feeling of weakness
Dizziness
Red and sore tongue

Is Malabsorption painful?

Yes, it can be especially if you are experiencing abdominal pain.

Who is at risk of Malabsorption in Singapore?

Malabsorption can affect anyone. But if you have the following factors, you are at an increased risk of getting malabsorption:

Celiac disease
Cystic fibrosis
Crohn’s disease
Prolonged use of antibiotics or laxatives
Surgery on the intestines

How is Malabsorption diagnosed?

If your gastroenterologist suspects that you have malabsorption, the following tests may be conducted:

Gastroscopy: a thin, flexible tube with a camera and light attached at one end is inserted into your mouth and guided through the oesophagus and into your stomach and small intestine to check for any abnormalities. If anything out of the ordinary is spotted, a sample is taken and sent for biopsy.
Stool test: your stool is tested for fat. If too much fat is found, you may have malabsorption.
Sweat test: a sample of sweat can be tested to check for cystic fibrosis, which could signal possible malabsorption.
Lactose hydrogen breath test: this checks how much hydrogen is present when you breathe out after you drink a lactose drink.

What are the treatment options for Malabsorption in Singapore?

The treatment for malabsorption depends on the cause of it. Some treatment options include:

Avoiding trigger foods (e.g., avoid dairy if you are lactose intolerant)
Take supplements of the nutrients that your small intestine is unable to absorb
Medications can help if your malabsorption is caused by an overactive gastrointestinal tract
Replacement of digestive enzymes

Frequently asked questions

Can malabsorption be cured?

This depends on the underlying cause of your malabsorption. In some cases, the symptoms of malabsorption can be reduced with simple lifestyle changes. But in cases where the underlying cause is something serious like cystic fibrosis, there is no cure.

Can a blood test detect malabsorption?

No. Malabsorption can only be diagnosed using the tests mentioned above.

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General

Liver

Oesophagus

Biliary/Pancreas

Stomach/Duodenum

Intestinal