Malabsorption: Difference between revisions

	Malabsorption
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Overview
Classification Infection Structural defect Digestive failure Systemic disease Iatrogenic
Differentiating Malabsorption from other Diseases

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Revision as of 20:49, 5 February 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

Malabsorption is a condition which is associated with impaired absorption of one or all dietary nutrients. There are multiple etiologies with diminished intestinal absorption. Many of them present with diarrhea, especially steatorrhea. They might have malabsorption of carbohydrates, fat, protein, vitamins, and/or minerals. Malabsorption is occurred following intestinal mucosal or structural defects. Malabsorption according to etiology may be classified into five main groups of infection, structural defect, digestive failure, systemic disease, and iatrogenic causes.

Classification

Malabsorption according to etiology may be classified into five main groups:^[1]

Malabsorption classification
Infection
Viral	HIV
Bacterial	Tuberculosis
	Tropical sprue
	Whipple's disease
	Small intestinal bacterial overgrowth syndrome
Parasitic	Giardia
Parasitic	Isospora
Structural or enzyme defect
Blind loop syndrome
Fistula
Diverticula
Stricture
Lactase deficiency
Digestive failure
Pancreatic insufficiency	Cystic fibrosis
	Chronic pancreatitis
	Pancreatic cancer
Zollinger–Ellison syndrome
VIPoma
Carcinoid syndrome
Bile acid malabsorption
Systemic disease
Celiac disease
Inflammatory bowel disease	Crohn's disease
Inflammatory bowel disease	Ulcerative colitis
Infiltrative disorders	Amyloidosis
	Lymphoma
	Eosinophilic gastroenteritis
Endocrine abnormalities	Diabetes mellitus
	Hypothyroidism
	Hyperthyroidism
	Hyperparathyroidism
	Hypoparathyroidism
	Addison's disease
Immunologic disorders	Common variable immunodeficiency
Immunologic disorders	Abetalipoproteinemia
Iatrogenic
Medication
Radiation
Post surgery	Gastrectomy
	Bariatric surgery
	Short bowel syndrome

Differentiating malabsorption from other Diseases

To review the complete differential diagnosis of diarrhea, click here.

The following table outlines the major differential diagnoses of malabsorption.^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12]^[13]^[14]^[15]^[16]^[17]^[18]^[19]^[20]^[21]^[22]^[23]^[24]^[25]^[26]^[27]^[28]^[29]^[30]^[31]

			Symptoms								Findings
Categories		Cause	Clinical manifestation									Lab findings
			Duration		Diarrhea			Fever	Abdominal pain	Weight loss
			Duration		Diarrhea							Stool exam	CBC
			Acute	Chronic	Watery	Bloody	Fatty					Stool exam	WBC	Hgb	Plt
Gastrointestinal		Crohn's disease	–	+	+	+	+	±	+	+	Abdominal tenderness Oral mucosal lesions Uveitis Arthritis Erythema nodosum Pyoderma gangrenosum	WBC + RBC +	↑	↓	↑
		Ulcerative colitis	–	+	+	+	+	±	+	+	Abdominal tenderness Blood on rectal examination Skin rash Iritis Uveitis Seronegative arthritis	WBC + RBC +	↑	↓	↑
		Celiac disease	–	+	±	–	±	–	+	+	Abdominal distention Increased bowel sounds Oral mucosal lesions Hepatosplenomegaly Ascites Dementia Dermatitis herpetiformis	Fat droplets on sudan stain	Nl	↓	Nl
		Cause	Duration		Diarrhea			Fever	Abdominal pain	Weight loss	Findings	Stool exam	CBC
		Cause	Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	Findings	Stool exam	WBC	Hgb	Plt
		Cystic fibrosis	–	+	–	–	+	±	+	+	Abdominal distention Hepatosplenomegaly Rectal prolapse Recurrent respiratory tract infection Bronchiectasis	Fat droplets on sudan stain	Nl	↓	Nl
		Chronic pancreatitis	–	+	+	–	+	–	+	+	Abdominal tenderness Pancreatic pseudocyst Diabetes mellitus	Fat droplets on sudan stain Fecal elastase +	Nl	Nl	Nl
		Bile acid malabsorption	–	+	+	–	+	–	–	+	Malabsorption Hypotension Tachycardia	Fat droplets on sudan stain	Nl	Nl	Nl
		Lactose intolerance	+	+	+	–	–	–	+	–	Abdominal tenderness Abdominal distention Headache Vertigo Memory impairment Lethargy	–	Nl	Nl	Nl
Infection	Bacterial	Cause	Duration		Diarrhea			Fever	Abdominal pain	Weight loss	Findings	Stool exam	CBC
		Cause	Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	Findings	Stool exam	WBC	Hgb	Plt
		Whipple's disease	–	+	+	–	+	±	+	+	Hepatosplenomegaly Ascites Abnormal extraocular movement Lymphadenopathy Hyperpigmentation Uveitis Endocarditis Encephalitis Dementia	Fecal fat +	↓	↓	↓/↑
		Tropical sprue	+	+	+	–	+	+	+	+	Angular stomatitis Oral mucosal lesion Myalgia Neuropathy Edema	WBC + Stool culture +	Nl	↓	Nl
		Small bowel bacterial overgrowth	–	+	+	–	+	–	+	+	Abdominal distention Rosacea	WBC + Stool culture + Fecal fat +	Nl	↓	Nl
		Cause	Duration		Diarrhea			Fever	Abdominal pain	Weight loss	Findings	Stool exam	CBC
		Cause	Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	Findings	Stool exam	WBC	Hgb	Plt
	Virus	HIV	–	+	+	–	–	+	+	+	Abdominal distention Diffuse abdominal tenderness Lymphadenopathy Disseminated infection	WBC +	↓	↓	Nl
	Parasite	Giardia	–	+	+	–	+	–	+	+	Abdominal distention Diffuse abdominal tenderness Urticaria Depression	Ova +	Nl	Nl	Nl
	Parasite	Isospora	+	+	+	–	+	+	+	+	Abdominal distention Diffuse abdominal tenderness	WBC + RBC + Ova + Fecal fat +	↑	Nl	Nl
Tumors		VIPoma	+	+	+	–	+	–	+	+	Abdominal distention Abdominal RUQ tenderness Nausea Vomiting Rash Facial flushing Dehydration Lethargy Muscle weakness	–	Nl	Nl	Nl
		Zollinger–Ellison syndrome	–	+	+	+	+	–	+	+	Epigastric tenderness Jaundice	–	Nl	↓	Nl
		Cause	Duration		Diarrhea			Fever	Abdominal pain	Weight loss	Findings	Stool exam	CBC
		Cause	Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	Findings	Stool exam	WBC	Hgb	Plt
		Lymphoma	–	+	+	+	–	+	+	+	Diffuse abdominal tenderness Hepatosplenomegaly Ascites	RBC +	Nl	↓	Nl
Medication/Toxicity		ACE inhibitors Digoxin Cephalosporins Statins Thiazide diuretics Triptans Lactulose Anti retroviral agents Chemotherapeutic agents Antifungals Magnesium	+	+	+	–	±	±	+	+	Abdominal distention Dehydration	–	↑	Nl	Nl
Iatrogenic		Short bowel syndrome	+	+	+	–	+	–	–	+	Abdominal distention Abdominal tenderness Prior intestinal surgery Peripheral edema Muscle atrophy	Fecal fat +	Nl	↓	↑
Iatrogenic		Radiation enteritis	+	+	+	+	+	–	+	+	Abdominal tenderness Prior history of malignancy and radiation therapy Telangiectasias	WBC + RBC + Fecal fat +	Nl	↓	Nl
Others		Cause	Duration		Diarrhea			Fever	Abdominal pain	Weight loss	Findings	Stool exam	CBC
		Cause	Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	Findings	Stool exam	WBC	Hgb	Plt
		Abetalipoproteinemia	–	+	+	–	+	–	+	+	Abdominal distension Ataxia Visual field defect Dysarthria	–	Nl	Nl	Nl
		Hyperthyroidism	–	+	+	–	–	±	+	+	Lump in the neck Lid lag Sweating Hyperpigmentation Proptosis Tremor Increased DTR	Fecal fat +	Nl	Nl	Nl
		Diabetic neuropathy	–	+	+	–	+	–	+	+	Fecal incontinence	Fecal fat +	Nl	↓	Nl
		Systemic sclerosis	–	+	+	±	+	–	+	+	Epigastric tenderness Fecal incontinence Raynaud phenomenon Pulmonary hypertension Arthritis Telangiectasia Chronic renal failure	RBC + Fecal fat +	Nl	↓	Nl

References

↑ Papadia C, Di Sabatino A, Corazza GR, Forbes A (2014). "Diagnosing small bowel malabsorption: a review". Intern Emerg Med. 9 (1): 3–8. doi:10.1007/s11739-012-0877-7. PMID 23179329.
↑ Casburn-Jones, Anna C; Farthing, Michael Jg (2004). "Traveler's diarrhea". Journal of Gastroenterology and Hepatology. 19 (6): 610–618. doi:10.1111/j.1440-1746.2003.03287.x. ISSN 0815-9319.
↑ Kamat, Deepak; Mathur, Ambika (2006). "Prevention and Management of Travelers' Diarrhea". Disease-a-Month. 52 (7): 289–302. doi:10.1016/j.disamonth.2006.08.003. ISSN 0011-5029.
↑ Pfeiffer, Margaret L.; DuPont, Herbert L.; Ochoa, Theresa J. (2012). "The patient presenting with acute dysentery – A systematic review". Journal of Infection. 64 (4): 374–386. doi:10.1016/j.jinf.2012.01.006. ISSN 0163-4453.
↑ Barr W, Smith A (2014). "Acute diarrhea". Am Fam Physician. 89 (3): 180–9. PMID 24506120.
↑ Amil Dias J (2017). "Celiac Disease: What Do We Know in 2017?". GE Port J Gastroenterol. 24 (6): 275–278. doi:10.1159/000479881. PMID 29255768.
↑ Kotloff KL, Riddle MS, Platts-Mills JA, Pavlinac P, Zaidi A (2017). "Shigellosis". Lancet. doi:10.1016/S0140-6736(17)33296-8. PMID 29254859. Vancouver style error: initials (help)
↑ Yamamoto-Furusho, J.K.; Bosques-Padilla, F.; de-Paula, J.; Galiano, M.T.; Ibañez, P.; Juliao, F.; Kotze, P.G.; Rocha, J.L.; Steinwurz, F.; Veitia, G.; Zaltman, C. (2017). "Diagnóstico y tratamiento de la enfermedad inflamatoria intestinal: Primer Consenso Latinoamericano de la Pan American Crohn's and Colitis Organisation". Revista de Gastroenterología de México. 82 (1): 46–84. doi:10.1016/j.rgmx.2016.07.003. ISSN 0375-0906.
↑ Borbély, Yves M; Osterwalder, Alice; Kröll, Dino; Nett, Philipp C; Inglin, Roman A (2017). "Diarrhea after bariatric procedures: Diagnosis and therapy". World Journal of Gastroenterology. 23 (26): 4689. doi:10.3748/wjg.v23.i26.4689. ISSN 1007-9327.
↑ Crawford, Sue E.; Ramani, Sasirekha; Tate, Jacqueline E.; Parashar, Umesh D.; Svensson, Lennart; Hagbom, Marie; Franco, Manuel A.; Greenberg, Harry B.; O'Ryan, Miguel; Kang, Gagandeep; Desselberger, Ulrich; Estes, Mary K. (2017). "Rotavirus infection". Nature Reviews Disease Primers. 3: 17083. doi:10.1038/nrdp.2017.83. ISSN 2056-676X.
↑ Kist M (2000). "[Chronic diarrhea: value of microbiology in diagnosis]". Praxis (Bern 1994) (in German). 89 (39): 1559–65. PMID 11068510.
↑ Guerrant RL, Shields DS, Thorson SM, Schorling JB, Gröschel DH (1985). "Evaluation and diagnosis of acute infectious diarrhea". Am. J. Med. 78 (6B): 91–8. PMID 4014291.
↑ López-Vélez R, Turrientes MC, Garrón C, Montilla P, Navajas R, Fenoy S, del Aguila C (1999). "Microsporidiosis in travelers with diarrhea from the tropics". J Travel Med. 6 (4): 223–7. PMID 10575169.
↑ Wahnschaffe, Ulrich; Ignatius, Ralf; Loddenkemper, Christoph; Liesenfeld, Oliver; Muehlen, Marion; Jelinek, Thomas; Burchard, Gerd Dieter; Weinke, Thomas; Harms, Gundel; Stein, Harald; Zeitz, Martin; Ullrich, Reiner; Schneider, Thomas (2009). "Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas". Scandinavian Journal of Gastroenterology. 42 (3): 391–396. doi:10.1080/00365520600881193. ISSN 0036-5521.
↑ Mena Bares LM, Carmona Asenjo E, García Sánchez MV, Moreno Ortega E, Maza Muret FR, Guiote Moreno MV, Santos Bueno AM, Iglesias Flores E, Benítez Cantero JM, Vallejo Casas JA (2017). "75SeHCAT scan in bile acid malabsorption in chronic diarrhoea". Rev Esp Med Nucl Imagen Mol. 36 (1): 37–47. doi:10.1016/j.remn.2016.08.005. PMID 27765536.
↑ Gibson RJ, Stringer AM (2009). "Chemotherapy-induced diarrhoea". Curr Opin Support Palliat Care. 3 (1): 31–5. doi:10.1097/SPC.0b013e32832531bb. PMID 19365159.
↑ Abraham BP, Sellin JH (2012). "Drug-induced, factitious, & idiopathic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 633–48. doi:10.1016/j.bpg.2012.11.007. PMID 23384808.
↑ Reintam Blaser A, Deane AM, Fruhwald S (2015). "Diarrhoea in the critically ill". Curr Opin Crit Care. 21 (2): 142–53. doi:10.1097/MCC.0000000000000188. PMID 25692805.
↑ McMahan ZH, DuPont HL (2007). "Review article: the history of acute infectious diarrhoea management--from poorly focused empiricism to fluid therapy and modern pharmacotherapy". Aliment. Pharmacol. Ther. 25 (7): 759–69. doi:10.1111/j.1365-2036.2007.03261.x. PMID 17373914.
↑ Schiller LR (2012). "Definitions, pathophysiology, and evaluation of chronic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 551–62. doi:10.1016/j.bpg.2012.11.011. PMID 23384801.
↑ Giannella RA (1986). "Chronic diarrhea in travelers: diagnostic and therapeutic considerations". Rev. Infect. Dis. 8 Suppl 2: S223–6. PMID 3523719.
↑ Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR; et al. (2005). "Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology". Can J Gastroenterol. 19 Suppl A: 5A–36A. PMID 16151544.
↑ Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D (2002). "Bowel habits and bile acid malabsorption in the months after cholecystectomy". Am J Gastroenterol. 97 (7): 1732–5. doi:10.1111/j.1572-0241.2002.05779.x. PMID 12135027.
↑ Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R; et al. (1991). "Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia". Gastroenterology. 100 (2): 359–69. PMID 1702075.
↑ RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC (1960). "Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue". Gastroenterology. 38: 28–49. PMID 14439871.
↑ Konvolinka CW (1994). "Acute diverticulitis under age forty". Am J Surg. 167 (6): 562–5. PMID 8209928.
↑ Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006). "The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications". Gut. 55 (6): 749–53. doi:10.1136/gut.2005.082909. PMC 1856208. PMID 16698746.
↑ Haque R, Huston CD, Hughes M, Houpt E, Petri WA (2003). "Amebiasis". N Engl J Med. 348 (16): 1565–73. doi:10.1056/NEJMra022710. PMID 12700377.
↑ Hertzler SR, Savaiano DA (1996). "Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance". Am J Clin Nutr. 64 (2): 232–6. PMID 8694025.
↑ Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC (1997). "Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect?". Gut. 41 (5): 632–5. PMC 1891556. PMID 9414969.
↑ BLACK-SCHAFFER B (1949). "The tinctoral demonstration of a glycoprotein in Whipple's disease". Proc Soc Exp Biol Med. 72 (1): 225–7. PMID 15391722.

[pmid23179329-1] Papadia C, Di Sabatino A, Corazza GR, Forbes A (2014). "Diagnosing small bowel malabsorption: a review". Intern Emerg Med. 9 (1): 3–8. doi:10.1007/s11739-012-0877-7. PMID 23179329.

[Casburn-JonesFarthing2004-2] Casburn-Jones, Anna C; Farthing, Michael Jg (2004). "Traveler's diarrhea". Journal of Gastroenterology and Hepatology. 19 (6): 610–618. doi:10.1111/j.1440-1746.2003.03287.x. ISSN 0815-9319.

[KamatMathur2006-3] Kamat, Deepak; Mathur, Ambika (2006). "Prevention and Management of Travelers' Diarrhea". Disease-a-Month. 52 (7): 289–302. doi:10.1016/j.disamonth.2006.08.003. ISSN 0011-5029.

[PfeifferDuPont2012-4] Pfeiffer, Margaret L.; DuPont, Herbert L.; Ochoa, Theresa J. (2012). "The patient presenting with acute dysentery – A systematic review". Journal of Infection. 64 (4): 374–386. doi:10.1016/j.jinf.2012.01.006. ISSN 0163-4453.

[pmid24506120-5] Barr W, Smith A (2014). "Acute diarrhea". Am Fam Physician. 89 (3): 180–9. PMID 24506120.

[pmid29255768-6] Amil Dias J (2017). "Celiac Disease: What Do We Know in 2017?". GE Port J Gastroenterol. 24 (6): 275–278. doi:10.1159/000479881. PMID 29255768.

[pmid29254859-7] Kotloff KL, Riddle MS, Platts-Mills JA, Pavlinac P, Zaidi A (2017). "Shigellosis". Lancet. doi:10.1016/S0140-6736(17)33296-8. PMID 29254859. Vancouver style error: initials (help)

[Yamamoto-FurushoBosques-Padilla2017-8] Yamamoto-Furusho, J.K.; Bosques-Padilla, F.; de-Paula, J.; Galiano, M.T.; Ibañez, P.; Juliao, F.; Kotze, P.G.; Rocha, J.L.; Steinwurz, F.; Veitia, G.; Zaltman, C. (2017). "Diagnóstico y tratamiento de la enfermedad inflamatoria intestinal: Primer Consenso Latinoamericano de la Pan American Crohn's and Colitis Organisation". Revista de Gastroenterología de México. 82 (1): 46–84. doi:10.1016/j.rgmx.2016.07.003. ISSN 0375-0906.

[BorbélyOsterwalder2017-9] Borbély, Yves M; Osterwalder, Alice; Kröll, Dino; Nett, Philipp C; Inglin, Roman A (2017). "Diarrhea after bariatric procedures: Diagnosis and therapy". World Journal of Gastroenterology. 23 (26): 4689. doi:10.3748/wjg.v23.i26.4689. ISSN 1007-9327.

[CrawfordRamani2017-10] Crawford, Sue E.; Ramani, Sasirekha; Tate, Jacqueline E.; Parashar, Umesh D.; Svensson, Lennart; Hagbom, Marie; Franco, Manuel A.; Greenberg, Harry B.; O'Ryan, Miguel; Kang, Gagandeep; Desselberger, Ulrich; Estes, Mary K. (2017). "Rotavirus infection". Nature Reviews Disease Primers. 3: 17083. doi:10.1038/nrdp.2017.83. ISSN 2056-676X.

[pmid11068510-11] Kist M (2000). "[Chronic diarrhea: value of microbiology in diagnosis]". Praxis (Bern 1994) (in German). 89 (39): 1559–65. PMID 11068510.

[pmid4014291-12] Guerrant RL, Shields DS, Thorson SM, Schorling JB, Gröschel DH (1985). "Evaluation and diagnosis of acute infectious diarrhea". Am. J. Med. 78 (6B): 91–8. PMID 4014291.

[pmid10575169-13] López-Vélez R, Turrientes MC, Garrón C, Montilla P, Navajas R, Fenoy S, del Aguila C (1999). "Microsporidiosis in travelers with diarrhea from the tropics". J Travel Med. 6 (4): 223–7. PMID 10575169.

[WahnschaffeIgnatius2009-14] Wahnschaffe, Ulrich; Ignatius, Ralf; Loddenkemper, Christoph; Liesenfeld, Oliver; Muehlen, Marion; Jelinek, Thomas; Burchard, Gerd Dieter; Weinke, Thomas; Harms, Gundel; Stein, Harald; Zeitz, Martin; Ullrich, Reiner; Schneider, Thomas (2009). "Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas". Scandinavian Journal of Gastroenterology. 42 (3): 391–396. doi:10.1080/00365520600881193. ISSN 0036-5521.

[pmid27765536-15] Mena Bares LM, Carmona Asenjo E, García Sánchez MV, Moreno Ortega E, Maza Muret FR, Guiote Moreno MV, Santos Bueno AM, Iglesias Flores E, Benítez Cantero JM, Vallejo Casas JA (2017). "75SeHCAT scan in bile acid malabsorption in chronic diarrhoea". Rev Esp Med Nucl Imagen Mol. 36 (1): 37–47. doi:10.1016/j.remn.2016.08.005. PMID 27765536.

[pmid19365159-16] Gibson RJ, Stringer AM (2009). "Chemotherapy-induced diarrhoea". Curr Opin Support Palliat Care. 3 (1): 31–5. doi:10.1097/SPC.0b013e32832531bb. PMID 19365159.

[pmid23384808-17] Abraham BP, Sellin JH (2012). "Drug-induced, factitious, & idiopathic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 633–48. doi:10.1016/j.bpg.2012.11.007. PMID 23384808.

[pmid25692805-18] Reintam Blaser A, Deane AM, Fruhwald S (2015). "Diarrhoea in the critically ill". Curr Opin Crit Care. 21 (2): 142–53. doi:10.1097/MCC.0000000000000188. PMID 25692805.

[pmid17373914-19] McMahan ZH, DuPont HL (2007). "Review article: the history of acute infectious diarrhoea management--from poorly focused empiricism to fluid therapy and modern pharmacotherapy". Aliment. Pharmacol. Ther. 25 (7): 759–69. doi:10.1111/j.1365-2036.2007.03261.x. PMID 17373914.

[pmid23384801-20] Schiller LR (2012). "Definitions, pathophysiology, and evaluation of chronic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 551–62. doi:10.1016/j.bpg.2012.11.011. PMID 23384801.

[pmid3523719-21] Giannella RA (1986). "Chronic diarrhea in travelers: diagnostic and therapeutic considerations". Rev. Infect. Dis. 8 Suppl 2: S223–6. PMID 3523719.

[pmid16151544-22] Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR; et al. (2005). "Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology". Can J Gastroenterol. 19 Suppl A: 5A–36A. PMID 16151544.

[pmid12135027-23] Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D (2002). "Bowel habits and bile acid malabsorption in the months after cholecystectomy". Am J Gastroenterol. 97 (7): 1732–5. doi:10.1111/j.1572-0241.2002.05779.x. PMID 12135027.

[pmid1702075-24] Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R; et al. (1991). "Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia". Gastroenterology. 100 (2): 359–69. PMID 1702075.

[pmid14439871-25] RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC (1960). "Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue". Gastroenterology. 38: 28–49. PMID 14439871.

[pmid8209928-26] Konvolinka CW (1994). "Acute diverticulitis under age forty". Am J Surg. 167 (6): 562–5. PMID 8209928.

[pmid16698746-27] Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006). "The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications". Gut. 55 (6): 749–53. doi:10.1136/gut.2005.082909. PMC 1856208. PMID 16698746.

[pmid12700377-28] Haque R, Huston CD, Hughes M, Houpt E, Petri WA (2003). "Amebiasis". N Engl J Med. 348 (16): 1565–73. doi:10.1056/NEJMra022710. PMID 12700377.

[pmid8694025-29] Hertzler SR, Savaiano DA (1996). "Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance". Am J Clin Nutr. 64 (2): 232–6. PMID 8694025.

[pmid9414969-30] Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC (1997). "Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect?". Gut. 41 (5): 632–5. PMC 1891556. PMID 9414969.

[pmid15391722-31] BLACK-SCHAFFER B (1949). "The tinctoral demonstration of a glycoprotein in Whipple's disease". Proc Soc Exp Biol Med. 72 (1): 225–7. PMID 15391722.

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@@ Line 4: / Line 4: @@
 ==[[Malabsorption overview|Overview]]==
-Malabsorption is a condition which is associated with impaired [[absorption]] of one or all dietary [[Nutrient|nutrients]]. There are multiple etiologies with diminished [[Intestine|intestinal]] [[absorption]]. Many of them present with [[diarrhea]], especially [[steatorrhea]]. They might have malabsorption of [[Carbohydrate|carbohydrates]], [[fat]], [[protein]], [[Vitamin|vitamins]], and/or [[Mineral|minerals]].
+Malabsorption is a condition which is associated with impaired [[absorption]] of one or all dietary [[Nutrient|nutrients]]. There are multiple etiologies with diminished [[Intestine|intestinal]] [[absorption]]. Many of them present with [[diarrhea]], especially [[steatorrhea]]. They might have malabsorption of [[Carbohydrate|carbohydrates]], [[fat]], [[protein]], [[Vitamin|vitamins]], and/or [[Mineral|minerals]]. Malabsorption is occurred following [[Intestine|intestinal]] [[Mucous membrane|mucosal]] or structural defects. Malabsorption according to etiology may be classified into five main groups of [[infection]], structural defect, [[Digestive system|digestive]] failure, systemic disease, and [[Iatrogenesis|iatrogenic]] causes.
 ==[[Malabsorption classification|Classification]]==