2/18/12

Malabsorption Syndrome: Causes, Symptoms, Cancer Connection

How likely is malabsorption syndrome caused by cancer? Is there a way you can tell at home if you have this gastrointestinal ailment? 

This is when food fails to get adequately absorbed into your system; symptoms include diarrhea with particles of undigested food, very foul-smelling stools, abdominal cramping, dehydration and weight loss. Constipation is not a symptom.

If you’ve been having these symptoms, you might think it’s malabsorption syndrome; you may then think, “Thank goodness it’s not cancer.” 

However, what might be the cause of the syndrome in the first place? Cancer is a possible cause, but not a likely cause. I consulted with Ned Snyder, MD, Chief of Gastroenterology, Kelsey-Seybold Clinic, Houston, Texas.

There are numerous causes for malabsorption syndrome other than cancer, including bacterial overgrowth in the small intestine; chronic pancreatitis; celiac disease; surgical procedures; parasitic infections; and viral/bacterial infections.

Is a hallmark sign of this ailment oil droplets in the toilet water? Dr. Snyder explains, “Oil slicks and droplets are characteristic of patients with very significant and gross fat malabsorption. In some types of malabsorption, the primary substance that is not absorbed may not always be fat.”

“For instance, if one has disease of the terminal ileum or a previous surgical resection of this area, then B12 and bile salts will be malabsorbed, and the stool can be normal or liquid after meals, and the patient will be anemic.  In celiac disease, the fat malabsorption may be modest and the primary presenting problems could be anemia from iron malabsorption or bad bones because of poor absorption of calcium and vitamin D.”

Do stools here have a typical, characteristic appearance? “It really depends again upon what is malabsorbed,” says Dr. Snyder. “There are many manifestations of malabsorption, and only a minority of cases have the classic features (stools that are greasy, oily, bulky, foul-smelling). In classic fat malabsorption in chronic pancreatitis (or pancreatic cancer), the stools will be light colored, voluminous, float, and be oily.”

“However, all stools that float do not represent malabsorption. Also, one can have mild fat malabsorption, and have normal stools. If the malabsorption is for carbohydrates or bile salts, the stools can be watery. Protein malabsorption is primarily manifested by muscle wasting, weakness, etc.”

Just how much undigested food will a person typically see in their stools with this condition?
“Undigested food is primarily seen in only the most gross cases of fat malabsorption,” says Dr. Snyder.

Are stools with this condition always loose and diarrhea-like, or can stools be solidly formed? “If the malabsorption is selective for B12 or iron, the stool can be normal,” says Dr. Snyder. “However, when fat or bile salts are malabsorbed, the stools will be loose.”

What percentage, if known, of malabsorption syndrome is the result of cancer? Cancer is a rare cause, except in the elderly when cancer of the pancreas is the etiology of a small percentage of cases.” (The pancreas is the organ most commonly associated with malabsorption.)

How uncommon is pancreatic cancer in people under 50?I can’t provide an exact figure, but pancreatic cancer is highly unusual under the age of 50. I suspect approximately 5-8 percent of patients are 50 years of age or younger. The mean age is 72, and the incidence of the disease begins to go up sharply in a linear fashion after age 50.”

What is the most common cause of the syndrome in young adults? In middle aged people? In children? Dr. Snyder says, “Young adults: celiac disease; middle age: celiac disease and chronic pancreatitis; children: cystic fibrosis and celiac disease.”

Do the stools float all the time, or can they sometimes sink, with this condition? “They can sink.”

If a person suspects they have this, what should they tell their doctor? “Give a good history including a description of the diarrhea and weight loss, if any,” says Dr. Snyder. “Gastroenterologists often go straight to colonoscopy with a history of diarrhea. Colon diseases can cause diarrhea but not malabsorption, so a colonoscopy will not turn out to be helpful sometimes. Patients should ask for evaluations of their small bowel and pancreas.”

What conditions can mimic this ailment? Dr. Snyder explains, “Common diseases that can present like malabsorption but not usually associated with it include microscopic colitis, Crohn's disease, ulcerative colitis, infection with giardia, and irritable bowel syndrome. Lactose intolerance is common and sort of a malabsorption problem due to a deficiency of the enzyme lactase and should be mentioned as well.”


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