Mount Auburn Healthcare Connection

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Physicians at Mount Auburn Hospital in Cambridge, a teaching hospital of Harvard Medical School are leading the way in diagnosing and treating malabsorption with a unique combination of innovative and traditional procedures.

The digestion process in the human body begins after the ingestion of food. Part of the process is done in the stomach when acids begin to break down the food. Normally food is absorbed into the bloodstream in the small intestine but malabsorption occurs if there is an interference with the digestion or absorption of food.

“The small bowel is where absorption of nutrients is done and malabsorption occurs when the small bowel lining does not work,” explains Julio Ayala, M.D., Gastroenterologist at Mount Auburn Hospital in Cambridge.

According to Dr. Ayala, malabsorption can be caused by a number of factors including celiac disease, Crohn’s disease and lactose intolerance. Diseases such as celiac disease and Crohn’s disease injure the lining of the small intestine and may result in the removal of a portion of the absorptive lining. Conditions such as lactose intolerance keep nutrients from being absorbed properly due to a missing enzyme needed for absorption. Additional causes for malabsorption include cystic fibrosis, Whipple’s disease and parasites.

“One of the most common symptoms of malabsorption is diarrhea,” says Dr. Ayala. “Others are abdominal distention and pain and malnutrition.” Symptoms of malabsorption are frequently caused by the passage of unabsorbed nutrients through the digestive tract and by nutritional deficiencies that result from inadequate absorption. Deficiency of specific nutrients could result in the following symptoms:

· Calcium – Bone pain and deformities

· Folic Acid – Fatigue and weakness

· Iron – Fatigue and weakness

· Magnesium – Muscle spasms

· Niacin – diarrhea, skin disorders and confusion

· Protein – Tissue swelling, dry skin and hair loss

· Vitamin B12 – Fatigue and weakness, confusion

· Vitamin C – Weakness and bleeding gums

· Vitamin D – Bone thinning and pain

· Vitamin K – Easily bruised and tendency to bleed

Dr. Ayala says the condition is most often diagnosed through a series of steps. “One of the most important things is history and a physical examination, which gives some clinical guidance as to what condition the patient has,” says Dr. Ayala. “We also have a few specific tests to diagnose the condition. There is a hydrogen breath test where a patient breathes into a machine to gather information on what type of malabsorption is present. In addition, colonoscopy and upper endoscopy are sometimes used to access the small bowel. New technology such as video capsule endoscopy, which is a video capsule that is swallowed like a pill, is also used to see what is in the small bowel.”

Treatment of malabsorption is individualized, based on the specific cause of the condition. “For example, in the case of celiac disease, a gluten free diet is recommended,” says Dr. Ayala. “In the case of lactose intolerance there is lactase replacement.”

At Mount Auburn Hospital, physicians integrate new technologies into their diagnosis and treatment of malabsorption to ensure top-notch patient care. Dr. Ayala encourages people to consult their physicians if they experience any symptoms of malabsorption.

“When patients experience unexplained abdominal distention, flatulence, diarrhea and weight loss, they should consult their physicians,” he says.

For a free Mount Auburn Hospital physician directory, please call us at 617-499-5094.