3. Introduction
• It is defective absorption and transport of
digested macro and micronutrients in the
body.
• This will result in:
Maldigestion
True
malabsorption
4. Maldigestion:- impaired breakdown of nutrients to absorbable
split products.
Malabsorption:- defective mucosal uptake and transport of
adequately digested nutrients including vitamins and trace
elements.
Malabsorption syndrome (MAS):- it is a clinical term that
encompass defects occurring during the digestion and
absorption of food nutrients by gastrointestinal tract.
5. it may affect
Broad range individual/group
Of nutrients of nutrients
Pan specific
Malabsorption malabsorption
6. Epidemiology
It is common gastroenterology practice in tropics
including India.
Celiac disease is frequently reported as cause of
MAS in children and adult.
It was once known as tropical spure in south
Indian villages.
7. Classifications
• It classify directly or indirectly based on the
causes.
Causes:
Maldigestion malabsorption
mucosal abnormality syndrome
Bacterial contamination
8. Physiology
• Digestion involve both mechanical and enzymatic breakdown
of food.
• Majority digestion occur in small intestine.
• jejunum is major site for absorption of most of nutrients
except:
• Ions absorbed in duodenum.
• Vit b12 and bile salts in ileum
• Water and lipid throughout the small intestine.
9. Causes
1. Digestive failure due to
- pancreatic insufficiencies
- bile salt insufficiencies
2. Structural defects
- gastrectomy, gastro- jejunostomy
- fistulae , diverticulae
short bowel syndrome
3. Mucosal abnormality
- coeliac disease
10. 4. Enzyme deficiencies
- lactose intolerance
- disaccharides deficiency
- enteropeptidases deficiency
5. Due to infective agents
- whipple’s diseases
- intestinal TB
- tropical sprue
- parasites
6. Due to other systemic diseases affecting GIT
- hyper or hypothyroidism
- DM
- hyper or hyperparathyroidism
- malnutrition
14. 1. Disturbed intestinal transit and SI bacterial overgrowth:
Ileal brake mechanism
in transit
small amount nutrient
passed to colon
without getting absorbed
which act as
energy source of colonic bacteria
exert regulatory mainly inhibitory affect on upper GI function
15. Rapid intestinal transit
high osmotic load
increased bacterial metabolism
disturb regulatory mechanism
Delayed intestinal transit
promote SI bacterial overgrowth
De-conjugation of bile acid due to enzymes
affect bile acid absorption
thus disturb lipid absorption
16. Disturbed
intestinal transit
• Interrupted macro/micro nutrient
absorption.
Exocrine
pancreatic
insufficiencies
• Poor pancreatic stimulation due to reduced
release of CCk
Impaired bile
synthesis and
secretion
• decreased luminal availability of bile
acids and lipid malabsorption
17. Celiac disease
• Abnormal immune reaction to gluten
Lactose intolerance
• Inadequate amount of lactase enzyme
Tropical
spure
• Atrophy of villi in small intestine
18. Sign & Symptoms
mainly depends on underlying pathology.
Common symptoms include:
-weight loss
-Chronic diarrhea
-Steatorrhea
-flatulence
-Anorexia
-Fatigue
-Anaemia
-Bone fragility
-Edema etc.
21. suspecting presence of malabsorption –
history and physical examination.
confirming its existence- hematological,
biochemistry, and absorption testing.
evaluating for the cause.
22. Diagnosis
• Done on basis of signs and symptoms.
• BLOOD TEST & BIOCHEMICAL TEST-- to reveal
Anemia -> microcytic or macrocytic.
Cholesterol or TG levels ->fat malabsorption.
Calcium &phosphate level ->(osteomalacia) low vit D
absorption.
Fat soluble vitamins are affected in fat malabsorption.
Prolonged prothrombin time -> vit K deficiency.
Specific vitamin or micronutrients level check.
ATG- Abs or anti- endomysial Abs -> celiac disease
23. STOOL STUDIES
microcytic examination -> reveal parasite, ova, cysts, and
other infective agents.
low fecal pancreatic elastase –> pancreatic insufficiency
Trypsin & chemotrypsin can be assessed.
RADIOLOGOCAL STUDIES:
barium follow or barium enema
CT abdomen.
24. INTERVENTIAL STUDIES
oesophago-gastroduodenoscopy
Enteroscopy
Colonoscopy
VCE (video capsule endoscopy)
ERCP ( endoscopic retrograde cholangiopancreatography)
Other test
Schilling test -> vit B12 malabsorption
D- xylose test
Lactose tolerance test
Qualitative and Quantitative fecal fat analysis
27. Aim of treatment
1. Eliminating toxins from body
2. complete rest to enhance self healing
3. diet and yoga as healing tools
28. Toxin elimination
1. Eliminative diet
2. hydro treatment like enema, cold hip bath, abdominal
pack or mud pack to abdomen
3. neem enema
4. other- full mud bath, sun bath, steam bath
This give sudden relief from all severe symptoms.
29. Complete rest
1. of both body and mind
2. fasting according to severity
3. after cleansing go for soothening diet
4. constructive diet
A healthy diet should comprise 2o% acidic and 80% alkaline food.
Fiber, curd and gluten free diet help to restore gut bacteria.
Balanced food is essential for healthy life.
30. Yoga: therapeutic tool
1. Asanas
- which compress and stretch abdomen
2. Pranayamas
- nadi shodhana, Kapalbhati, bhastrika ( avoiding during severe IBD)
- cooling pranayamas
3. Kriyas
- vamana dhauti and shankhaprakshalana
shankhaprakshalana helps at mucosal level .it helps in removing the
defective mucous layer, and after practice eating of khichdi help in regaining
the health and corrects absorption process.
31. 4. Meditation
- reduce stress and promote self healing
Precautions :-
• avoid giving raw food in ulcers conditions, as it may
worsen the condition.
• suggest any practice according to the conditions of patient.
32. Role of Counseling
• Educate patient to take healthy diet, daily exercise and
positive thoughts
• Also advised how to deal with acute diseases in future so
that healing will be complete.
33. Dosage in interventions
• health of digestive system is giver priority.
• complete nutritional supplements are necessary.
• hydro modality give with aim to assist inflammation.
• Treatment should be given for 15-30 days, followed by
once a week for next 30 days.
34. Follow up measures
• constructive should be follow.
• Yoga practice should be regular
• naturopathy interventions till complete restoration of
health.
