Syndrom der gestörten Nährstoffabsorption - Symptome und Behandlungsmöglichkeiten

The absorption surface area of the small intestine ranges from 200 to 400 m², with an average length of approximately 3 meters. This extensive absorption capacity is made possible by the intestinal villi, which are specialized projections in the intestinal wall that increase its surface area. Consumed food travels through the mouth and stomach into the duodenum (the first section of the small intestine) and then proceeds to the subsequent segments. One of the key functions of the small intestine is nutrient absorption. Different segments of the small intestine are responsible for the uptake of specific substances: the initial segment absorbs sugars, amino acids, fats, calcium, and iron; the middle segment primarily absorbs sugars and amino acids; and the final segment absorbs vitamin B12 and bile acids. If any stage of digestion is impaired, it may result in the body being unable to absorb essential nutrients. This occurs in the case of malabsorption syndrome.

The causes of excessive absorption syndrome are diverse. It is classified into primary and secondary forms. The primary form is associated with damage to the intestinal mucosa, while the secondary form results from abnormalities in earlier stages of digestion. Possible triggers include damage to the intestinal villi, which can occur in celiac disease if gluten is not eliminated from the diet, or as a consequence of prolonged fasting. Other factors include parasitic infections of the digestive tract such as tapeworm or roundworm, Crohn's disease, other intestinal inflammations, and digestive disorders at various stages – from inadequate chewing to gastric resections and exocrine pancreatic insufficiency, up to the removal of intestinal segments. Additionally, disturbances in the absorption of amino acids, vitamin B12, or simple sugars may occur. However, the mentioned causes are not exhaustive. Any disruption in digestion or absorption can lead to nutrient deficiencies, which may manifest in various ways.

Clinical manifestations depend on the specific nutrient whose absorption is impaired. In advanced cases where the disorder affects multiple nutrients, patients experience nausea, diarrhea, fatty stools, weight loss, and complications due to vitamin and mineral deficiencies. Due to the diverse nature of these deficits, various symptoms may arise, including iron deficiency anemia, neurological disorders, megaloblastic anemia, glossitis caused by vitamin B12 deficiency, scurvy due to vitamin C deficiency, skin and mucous membrane inflammations from vitamin B6 deficiency, growth impairments, edema, immune deficiency, emaciation, ulcers, cataracts, dry skin, alopecia, rickets, hemophilia, osteomalacia, osteoporosis.

There is no standardized treatment approach for impaired absorption syndrome. The therapy depends entirely on the underlying cause. A critical aspect of treatment is accurate diagnosis. Equally important is the correction of deficiencies through parenteral administration or the provision of digestive enzymes, if necessary. One rare (occurring in 0.01% of the population) and atypical cause is Whipple’s disease. Diagnosis is challenging due to the lack of typical symptoms. It presents with nausea, abdominal pain, lymph node enlargement, and weight loss. Often preceding these symptoms is migratory polyarthritis, which is rarely correctly associated. The disease is caused by the bacterium Tropheryma whippelii, with the mode of transmission still unclear. Due to its atypical course, Whipple’s disease is difficult to diagnose and often leads to severe nutritional deficiencies caused by intestinal changes such as infiltrations, wall swelling, and villous deformation. Most commonly, deficiencies in iron, vitamin D, protein, or calcium manifest—anemia, hypoalbuminemia, hypocalcemia. The disease is equally challenging to diagnose and treat. Antibiotic therapy does not guarantee complete control. The battle against the disease can last for years, with alternating phases of exacerbation and remission. Impaired absorption syndrome can have diverse causes and lead to severe complications. This highlights the critical role of nutrients in the body. A balanced diet that meets the body’s needs is essential. Learn more about impaired absorption syndrome!