The Pathophysiology of Malabsorption

Jutta Keller, Peter Layer, Jutta Keller, Peter Layer

Abstract

Physiological digestion and absorption of nutrients within the gastrointestinal tract requires a complex interaction between motor, secretory, digestive, and absorptive functions that is vulnerable to a multitude of potential disturbances which may lead to global or specific malabsorption syndromes. Potential pathomechanisms that are illustrated in this article include insufficient mechanical breakdown of harder food components due to chewing problems and/or decreased antral contractility, critical reduction of time for absorption in patients with markedly enhanced upper gastrointestinal transit (e.g. dumping syndrome), impaired digestion and absorption of nutrient components caused by reduced gastric acid secretion, pancreatic exocrine insufficiency or reduced biliary secretion, defects of the enteral mucosa with enzyme deficiencies (e.g. disaccharidases) or lack of specific carrier mechanisms (e.g. hexose or aminoacid transporters), and critical quantitative loss of intestinal mucosa in patients with short bowel syndrome.

Keywords: Gastric acid secretion; Malabsorption; Maldigestion; Motility disturbances; Pancreatic exocrine insufficiency.

References

    1. Keller J. Lennarz WJ, Lane MD, editors. Gastrointestinal digestion and absorption. Encyclopedia of Biological Chemistry, ed 2. Waltham, MA, Academic Press. 2013:354–359.
    1. Evenepoel P, Claus D, Geypens B, et al. Evidence for impaired assimilation and increased colonic fermentation of protein, related to gastric acid suppression therapy. Aliment Pharmacol Ther. 1998;12:1011–1019.
    1. Keller J. Brauchen wir Magensäure? Deutsch Med Wochenschr. 2012;137:4.
    1. Targownik LE, Lix LM, Leung S, Leslie WD. Proton-pump inhibitor use is not associated with osteoporosis or accelerated bone mineral density loss. Gastroenterology. 2010;138:896–904.
    1. Gray SL, LaCroix AZ, Larson J, et al. Proton pump inhibitor use, hip fracture, and change in bone mineral density in postmenopausal women: results from the Women's Health Initiative. Arch Intern Med. 2010;170:765–771.
    1. Ito T, Jensen RT. Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium. Curr Gastroenterol Rep. 2010;12:448–457.
    1. Layer P, Keller J. Gastric lipase and pancreatic exocrine insufficiency. Clin Gastroenterol Hepatol. 2005;3:25–27.
    1. Holtmann G, Kelly DG, Sternby B, DiMagno EP. Survival of human pancreatic enzymes during small bowel transit: effect of nutrients, bile acids, and enzymes. Am J Physiol. 1997;273:G553–G558.
    1. Keller J, Runzi M, Goebell H, Layer P. Duodenal and ileal nutrient deliveries regulate human intestinal motor and pancreatic responses to a meal. Am J Physiol. 1997;272:G632–G637.
    1. Layer P, Peschel S, Schlesinger T, Goebell H. Human pancreatic secretion and intestinal motility: effects of ileal nutrient perfusion. Am J Physiol. 1990;258:G196–G201.
    1. Keller J, Holst JJ, Layer P. Inhibition of human pancreatic and biliary output but not intestinal motility by physiological intraileal lipid loads. Am J Physiol Gastrointest Liver Physiol. 2006;290:G704–G709.
    1. Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut. 2005;54(suppl 6):vi1–28.
    1. Braud S, Ciufolini MA, Harosh I. Enteropeptidase: a gene associated with a starvation human phenotype and a novel target for obesity treatment. PloS One. 2012;7:e49612.
    1. DiMagno EP, Go VL, Summerskill WH. Relations between pancreatic enzyme ouputs and malabsorption in severe pancreatic insufficiency. N Engl J Med. 1973;288:813–815.
    1. Dominguez-Munoz JE, Iglesias-Garcia J, Vilarino-Insua M, Iglesias-Rey M. 13C-mixed triglyceride breath test to assess oral enzyme substitution therapy in patients with chronic pancreatitis. Clin Gastroenterol Hepatol. 2007;5:484–488.
    1. Stein J, Schuppan D. Coeliac disease-new pathophysiological findings und their implication for therapy. Viszeralmedizin. 2014;26:156–165.
    1. Thompson JS. Short bowel syndrome and malabsorption-causes and prevention. Viszeralmedizin. 2014;26:174–178.
    1. Rege A. The surgical approach to short bowel syndrome-autologous reconstruction versus transplantation. Viszeralmedizin. 2014;26:179–189.
    1. Keller J, Panter H, Layer P. Management of the short bowel syndrome after extensive small bowel resection. Best Pract Res Clin Gastroenterol. 2004;18:977–992.
    1. Layer P, Zinsmeister AR, DiMagno EP. Effects of decreasing intraluminal amylase activity on starch digestion and postprandial gastrointestinal function in humans. Gastroenterology. 1986;91:41–48.

Source: PubMed

3
구독하다