Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0024523 (malabsorption)
 7,319 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cystic fibrosis (CF) is the most frequent inheritable disease with a lethal course. One of the major problems of the disease is malabsorption and malnutrition, due to pancreatic insufficiency which is already present at birth in more than 85% of the patients. Characteristically the mucoid secretion products of the epithelial tissues in lung, pancreas, liver and intestine have a high viscosity. The pathophysiology is characterized by obstruction of these organs with secondary damage and finally destruction. For a long period intestinal obstruction syndromes in CF were ascribed only to the pancreatic insufficiency. Malabsorption is not only caused by enzyme deficiency but is also related to transport processes to the surface of the enterocytes. This indicates that the intestinal disorders in CF are partly the result of mucoid plugging and not only of pancreatic insufficiency. Recently in vitro studies have shown a blockade of secretion through chloride channels in the mucosal membrane of CF tissues. In vivo measurements of chloride fluxes in the rectum showed a disturbed regulation in CF patients. The high viscosity of the mucus and plugging is directly related to the diminished chloride secretion. So it is postulated that the abnormal chloride secretion is responsible for the intestinal obstruction and partially also for the malabsorption.
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PMID:Relationship between intestinal function and chloride secretion in patients with cystic fibrosis. 128 10

Many patients with the inflammatory bowel diseases, Crohn's disease, or ulcerative colitis have significant protein-calorie malnutrition and micronutrient deficiencies. Factors that contribute to these nutritional deficits include inadequate nutrient intake, malabsorption, excessive nutrient secretion across the diseased gastrointestinal tract, drug-nutrient interactions, and increased nutrient requirements. In this review, the use of enteral and parenteral nutrition support as primary therapy for active Crohn's disease and ulcerative colitis is discussed. Other roles for nutrition support in patients with inflammatory bowel disease, including preoperative nutrition support, nutritional treatment of intestinal fistulas and growth retardation, and home parenteral nutrition for gut failure, are also reviewed.
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PMID:Nutrition support in inflammatory bowel disease. 129 78

Crohn's disease involves a great risk of malnutrition. Malabsorption, bacterial contamination, frequent abdominal surgery, meal-related pain, protein loss through the damaged mucosa contribute to creating nutritional problems. Malnutrition can worsen the outcome, both in medical and surgical patients, and deteriorate an often already altered immune response. Weight loss, low levels of blood protein, electrolytes, micronutrients and vitamins are usually related to the extension of the mucosal damage. Nutritional assessment can be difficult due to oedema and bleeding, who interfere with both clinical and laboratory evaluation. The exact amount of nitrogen, lipids, minerals stool loss can be useful. It is widely accepted the use of nutritional support in Crohn's disease, but many Authors do not agree concerning the route (enteral or parenteral) and the kind of nutrient to be used. Still controversial is the role of nutrition: just support or real therapy? Most recent hypothesis concerning the pathogenesis of Crohn's disease indicate food and/or bacterial antigens as involved in determining the pathology. The "bowel rest", considered for many years as a fasting period necessarily supported by parenteral nutrition, can also be obtained by the temporarily reduction or stop in presenting those antigens to the bowel mucosa. This new concept can be achieved not only by parenteral nutrition, but with an enteral elemental diet as well. The elemental diet contains all nutrients in the simplest way and thus succeeds in lowering or eliminating the antigenic power. The reported results seem to indicate an equivalence of enteral and parenteral nutrition; anyway enteral is advisable when feasible, being more physiological and less expensive and involving a lower risk of serious complications.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Possibilities and limitations of nutritional support in Crohn disease]. 129 38

Involuntary weight loss or wasting indicative of severe protein energy malnutrition is a frequent complication of acquired immune deficiency syndrome (AIDS). Malnutrition, with its associated adverse effects on immunocompetence, may contribute to the progression of AIDS itself. Since death from wasting is ultimately related to the magnitude of tissue depletion, restoration of body cell mass may enhance survival. The mechanism of weight loss in AIDS has not been clearly elucidated. The etiology is likely to be multifactorial, the result of interactions between decreased caloric intake, malabsorption, and alterations in energy expenditure secondary to hormonal and/or metabolic abnormalities. Although weight loss is occasionally reversible with treatment of underlying infections and/or easily identifiable and reversible causes, the majority of patients are not this fortunate. Enteral and parenteral nutrition, which are expensive, cumbersome, and potentially morbid, have been suggested by some as therapeutic options. Megestrol acetate, a synthetic, orally active progestational agent, has been reported to stimulate appetite and weight gain. Data regarding the use of megestrol acetate for the treatment of cachexia related to human immunodeficiency virus (HIV) infection demonstrate convincingly its effectiveness in treating many patients with HIV-related anorexia and cachexia.
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PMID:HIV-related cachexia: potential mechanisms and treatment. 146 29

The most frequently suggested causes of malnutrition are as follows: poverty, low parental education, lack of sanitation, low food intake, malabsorption, diarrhea and other infections, poor feeding practices, family size, short birth intervals, maternal time availability, child rearing practices, and seasonality. The purpose of this study of 1178 children 0-59 months of age from 30 villages in Arua District, Uganda, was to assess the nutritional status of this population and to identify sensitive predictors of mortality and major causes of malnutrition. Anthropometric and socioeconomic and health-related data were obtained between February and March, 1987, on the randomly selected population. Follow-up after a year provided mortality data on the sampled population. The results showed that nutritional status before the first 5 months of life was satisfactory; deterioration followed. Wasting or low weight-for-height existed predominantly among those aged 6-24 months. Stunting was high after 5 months. The proportion of underweight children was greater in the 2nd year of life; improvement occurred thereafter. Mortality rates were around 10% during the first year and declined thereafter to .5% in the 4th year. Mortality was higher among those with low weight-for-age or weight-for-height. The relative risk for mortality was 3 at less than -3 standard deviation (SD) weight-for-age. For less than -2 weight-for-height the relative risk was 4.6. Mortality was higher for children 12 months of age. Weight-for-age was the most sensitive indicator of mortality for the percentage of survivors correctly identified over 88%; for lower specificity weight-for-height was a more sensitive indicator. Paternal occupation was the only household indicator related to child mortality; i.e., high mortality was related to a father's occupation as alcohol distributor, and low mortality, to his occupation as tobacco grower or businessman. In the stepwise multiple regression, a father's education was positively correlated with weight-for-age, and a mother's education, with height-for-age. Negative influences were age, breast feeding, use of unprotected water supplies in the dry season, skin infections, and diarrhea within 2 weeks before the survey. Paternal education was positively associated, and skin infections negatively association, with weight-for-height. Unrelated factors are identified; justification of significant factors is discussed.
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PMID:Determinants of child nutrition and mortality in north-west Uganda. 146 51

Pancreatic insufficiency is the second most important pathophysiological expression of cystic fibrosis (CF) and occurs in the majority of patients. It leads to fat malabsorption and high energy losses in the stools and is one of the major causes of malnutrition often seen in CF. Although the development of enteric-coated enzyme preparations offers a dramatic improvement in therapy, it is still difficult to achieve complete correction of fat malabsorption. The cause for this treatment failure is the relative acidic environment in the duodenum induced by a decreased pancreatic bicarbonate output. To improve the efficacy of enteric-coated preparations the dissolution of these preparations in the duodenum must be optimised in order to achieve a high intraduodenal enzyme concentration. With the aim to increase intraduodenal pH, additional therapy with H2-antagonists and oral prostaglandins has been tested without unequivocal success. Omeprazole, a gastric acid inhibitor with more potency and duration of action compared to H2-antagonists, improves the efficacy of enteric-coated capsules of pancreatin dramatically. With a daily dose of 20 mg in addition to Pancrease (3 x 4 capsules) near normalization of faecal fat excretion will be reached in most CF patients with persistent steatorrhoea.
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PMID:New modalities in the treatment of exocrine pancreatic insufficiency in cystic fibrosis. 147 Feb 78

Four patients with acute paracoccidioidomycosis, hypoalbuminemia, ascites and associated infections are reported. They have been admitted to hospital 35 times, 4 of them due to active paracoccidioidomycosis, 14 to associated infections, 14 to ascites, edema and diarrhoea and 3 to herniorrhaphy. Two of them recovered after sepsis and central nervous system, muscular and subcutaneous cryptococcosis. The remaining two died. One had infectious diarrhoea (S. flexneri), peritoneal tuberculosis and sepsis (S. epidermidis); the other had bacterial meningitis, erysipelas, beta-hemolytic Streptococcus sepsis and miliary tuberculosis. Their immunodeficiency was attributed to enteric protein loss and/or malabsorption and malnutrition and was recognized by reduced response to delayed hypersensitivity skin tests in four patients and hypogammaglobulinemia in three of them. The authors discuss the need for prospective studies to be carried out, aiming at the mechanisms involved in secondary infections. Alternatives for maintaining the patients' adequate nutritional state should be investigated, to guarantee proper immune response and thus the ability to control intervening infections in patients with juvenile paracoccidioidomycosis.
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PMID:Immunodeficiency secondary to juvenile paracoccidioidomycosis: associated infections. 148 Feb 6

Studies of body composition in acquired immunodeficiency syndrome (AIDS) patients demonstrated body cell mass depletion out of proportion to losses of body weight or fat. The timing of death from wasting was related to the extent rather than the specific cause. However, some patients remain stable for indefinite periods, indicating that wasting is not a constant phenomenon. The development of malnutrition is multifactorial and includes disorders of food intake, nutrient absorption and intermediary metabolism. Nutritional repletion has been demonstrated in several studies. The effect of treating infections that promote wasting was shown in a study of ganciclovir therapy for cytomegalovirus colitis, in which untreated patients underwent progressive wasting whereas treated patients repleted body mass. Total parenteral nutrition had a variable effect upon body composition, with repletion occurring in patients with eating disorders or malabsorption syndromes and progressive depletion occurring in patients with serious systemic infections. Enteral nutrition also can replete body mass in AIDS patients without severe malabsorption. Pharmacologic stimulation of appetite also may lead to weight gain. The results of these studies indicate that nutritional support can improve nutritional status in properly selected AIDS patients.
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PMID:Nutritional effects and support in the patient with acquired immunodeficiency syndrome. 154 39

Children, especially infants, require adequate calories and nutrients to meet the high demands of normal growth and development; protein, essential fatty acids, vitamins and minerals are all important in achieving this goal. Malnutrition results from deficiency in one or more of these basic nutrients. It may be caused by (1) insufficient dietary intake, (2) malabsorption, (3) poor utilization of nutrients, and (4) increased catabolism. A range of clinical and metabolic changes occurs as a result of profound and generalized abnormalities at a cellular level. Mucocutaneous changes constitute one of the variable and multisystemic clinical manifestations of malnutrition. Although some signs are characteristic of a specific nutrient deficiency, an overlap of skin manifestations is observed in multiple deficiency states. The periorificial glazed erythema and hair loss of zinc deficiency also may be seen in patients with essential fatty acid deficiency, biotinidase deficiency, and even kwashiorkor. Mucous membrane changes associated with deficiency of many water-soluble vitamins may likewise be difficult to distinguish.
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PMID:Skin signs of nutritional disorders. 155 Jul 20

Between 1979 and 1986 a prospective study was performed on 15 gastrectomized (Billroth II) patients, who were above 65 years old, with evidence of clinical malnutrition as defined by anthropometric criteria. Gastrectomy had been performed between 2 and 55 years before the study (29 +/- 12.87 years). In twelve patients weight loss was observed ranging from 5.85 and 11.91 kg in a mean period of 12.7 months immediately prior to admission. In 8 cases the initial diagnosis was of malignancy, in 2 cases of severe anemia, and in 1 case of severe malnutrition. Intestinal malabsorption (IMB) was observed in 5 cases and intestinal bacterial overgrowth (IBO) in 2 cases, and both diagnosis in 4 cases using stool fat test and D-xylose test for the diagnosis of IMB and urine determination of Urican for the diagnosis of IBO. In two patients the test were normal and they could not be performed in two other. In 3 patients malignancy could not be observed however one of them presented IMB and the other IMB and IBO. We conclude that gastrectomy when performed in earlier ages can cause malnutrition at an older age, provoking a sudden malnutrition suggestive of malignancy. Most of these patients present IMB and/or IBO. Since IBO can cause irreversible mucosal damage, it is discussed whether this could be the cause of this clinical picture.
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PMID:[Previous history of gastrectomy in the aged: a malnutrition with malignant aspect]. 156 52


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