Mechanisms of Malabsorption

Mechanisms of Malabsorption

Location

Disease

Mechanism

Luminal

Exocrine pancreatic insufficiency

Lack of pancreatic enzymes (maldigestion)

Luminal

Small intestinal dysbiosis

Bacterial activity: bile salt deconjugation, fatty acid hydroxylation, competition for cobalamin and nutrients

Mucosal

Infectious enteropathies

  • Protozoal

  • Fungal

  • Parasitic

Chronic inflammatory enteropathy

  • Immunosuppressive-responsive enteropathy/inflammatory bowel disease

  • Diet-responsive enteropathy

Neoplastic infiltration

Mucosal damage: inflammation, brush-border defects, disturbed enterocyte function, decreased surface area

Mucosal

Villous atrophy

Decrease in surface area, immature enterocytes due to increased cell turnover with decreased brush-border enzyme expression

Mucosal

Inherited and acquired brush-border enzyme deficiencies

Lactase deficiency, diffuse small intestinal disease

Postmucosal

Lymphangiectasia

Lymphatic obstruction impairs delivery of chylomicrons

Postmucosal

Vasculitis, portal hypertension

Impaired delivery