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Query: UMLS:C0024523 (malabsorption)
 7,319 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Malnutrition occurs commonly in patients with acquired immunodeficiency syndrome (AIDS). The efficacy of nutritional support is unknown. A prospective, longitudinal study was conducted to determine the effect of prolonged total parenteral nutrition on body composition in 12 AIDS patients. Five patients were malnourished because of problems with food intake or absorption, while seven had systemic infections, with or without a malabsorption syndrome. The AIDS patients gained body weight and body fat content in response to total parenteral nutrition, while mean body cell mass, estimated as total body potassium content, was unchanged. However, all five patients with altered intake or absorption had significant repletion of body cell mass which was significantly different from the patients with systemic infections. Calorie and nitrogen intake did not differ between the two groups. It is concluded that body mass repletion is possible in AIDS patients in whom malabsorption is the major pathogenetic factor in producing malnutrition and is less successful in patients with serious ongoing systemic diseases. Thus, the response to nutritional support is dependent on the particular clinical circumstances.
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PMID:Effect of home total parenteral nutrition on body composition in patients with acquired immunodeficiency syndrome. 212 17

Study of 40 patients with no digestive pathology, 20 of whom were subjected to surgery of the larynx or maxillo-facial surgery, with regard to tolerance of an enteral diet with polysaccharides of soya which contribute 25 gr of dietetic fibre per 2,000 kilocalories, compared to that of an enteral diet poor in fibre and very often used due to good clinical tolerance. An increase in the frequency of bowel movement was observed, and in the quantity of motions, although there was no simultaneous change in number of motions per day, consistency or appearance of the faeces. Subjective tolerance to the diet was good, and patients felt less full and bloated than those on a diet which was poor in fibre. There were no significant differences between both diets with regard to nitrogen balance or plasmatic levels in the diet. The better tolerance of this diet with polysaccharides of soya leads us to recommend it, especially in patients with great needs with regard to energy or volume, provided that there are no malabsorption symptoms.
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PMID:[Digestive tolerance for an enteral diet rich in fiber]. 248 48

The development of peptide-based enteral formulas is a significant milestone in the advancement of nutritional care of the nutritionally compromised patient. Although previously limited to specific gastrointestinal mucosal diseases, the use of peptide-based formulas has been extremely useful in the critically ill patient with impaired gastrointestinal absorption associated with hypoalbuminemia resulting from hypermetabolic states. Based on previous animal studies, several investigators have noted improved nitrogen absorption, greater nitrogen utilization, higher branched chain amino acid levels, and increased insulin secretion with the use of peptide-based formulas compared with intact protein or free amino acid diets. Recent studies have indicated an improved gastrointestinal tolerance with peptide-based diets, with the rate of absorption and the degree of tolerance dependent on the presence of small molecular weight peptides. In addition, we have found that the critically ill patient suffering from severe hypoalbuminemia frequently develops a protein-losing enteropathy, which can be attenuated by the use of a peptide-based formula. Thus, peptide-based formula may attenuate albumin turnover in the intestine and thus be efficacious in patients with a protein-losing enteropathy from a variety of etiologies (table 2). We therefore recommend that enteral support with a peptide-based diet is safe and extremely useful in the catabolic, critically ill patient or in patients with significant gastrointestinal malabsorption associated with a protein-losing enteropathy. Tolerance of these formulas is dependent on the catabolic state of the patient, with more catabolic patients needing higher concentrations of nitrogen in the form of peptides and/or supplemental parenteral branched chain amino acids.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:A reappraisal of the peptide-based enteral formulas: clinical applications. 251 72

This article describes the clinical approach to the aetiological diagnosis of chronic diarrhoea in adults, with a rational ranking of investigations starting with methodical questioning and careful physical examination. The purpose of the clinical stage is to find out whether the diarrhoea is truly chronic--and not the paradoxical diarrhoea so common in constipated subjects--, to evaluate its repercussions on nutrition and hydration, to try and determine its type (malabsorption or watery diarrhoea) and to elicit an obvious or probable cause. The paraclinical stage includes screening or confirmatory examinations separating watery diarrhoeas (due to colonic hypermotility or secretory of organic origin--mainly colonic, humoral or neurological--or functional origin) from malabsorption diarrhoeas; concerning the latter, the use respiratory tests with hydrogen is emphasized and conventional tests (D-xylose, assay of faecal fats and nitrogen) are mentioned.
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PMID:[Exploration of the adult patient with chronic diarrhea]. 260 89

The effect of a long acting somatostatin analogue SMS 201-995 on stomal effluents in patients with severe short bowel syndrome was investigated in a double blind placebo controlled balance study. Six patients, five with Crohn's disease and one with radiation enteropathy were studied. Five patients had a jejunostomy and one an ileostomy. The patients had a normal food intake, but because of severe malabsorption had received home parenteral nutrition for several years. Faecal mass was reduced (p less than 0.005) and intestinal net sodium absorption was increased (p less than 0.005) by intravenous infusion of SMS 25 micrograms/h. Net absorption of potassium, calcium, magnesium phosphate, zinc, nitrogen and fat was not influenced. Subcutaneous injections of 50 micrograms SMS every 12 hours had a similar effect on net intestinal absorption of sodium and water. Four patients continued with a five to six months open follow up study when subcutaneous SMS in the same dose was administered by the patients at home. The effect on faecal sodium loss persisted, but in one patient faecal mass gradually increased and finally exceeded pretreatment values. SMS may decrease net absorption of water and sodium following reduced secretion of digestive juices rather than by increasing absorptive capacity. SMS may be useful as an antidiarrhoeal drug in patients with high output jejuno- or ileostomies, but in patients who need permanent parenteral nutrition the effect is too small to significantly alter management.
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PMID:Effect of a long acting somatostatin analogue SMS 201-995 on jejunostomy effluents in patients with severe short bowel syndrome. 231 26

We investigated the nutritional state and pathophysiologic mechanisms involved in the malabsorption of 27 patients with total gastrectomy and esophagojejunostomy reconstruction without reservoir; they were first evaluated after a median period of 9 months after surgery and were not receiving either nutritional or pharmacologic support. Mean postoperative weight loss was -13.7 +/- 1.59%; mean daily caloric intake was 31.7 +/- 2.41 kcal/kg/day, with 70% of subjects ingesting less than 30 kcal/kg; P/kg was 1.2 +/- 0.09, with 21% of patients ingesting less than 1 g P/kg/day; mean ratio of nonprotein energy to 1 g nitrogen intake was 142 +/- 8.74:1, with only 24% of patients attaining a ratio greater than 150:1; and mean fat malabsorption was 37.4 +/- 4.6%. Hemoglobin (Hb), serum albumin, prealbumin iron, and folate were more often abnormal in the early postoperative period, whereas transferrin and vitamin B12 concentrations deteriorated later. alpha 1-Antitrypsin clearance was abnormal in almost all patients (indicating an intestinal protein loss), and the pancreolauryl test was abnormal in 60%. Neither morphological nor absorptive alterations of the small bowel nor an abnormal transit time or bacterial overgrowth was found. We conclude that inadequate caloric intake appears to be the main cause for malnutrition after total gastrectomy, but that caloric losses caused by steatorrhea and enteric protein leakage must be subtracted from intake, thus decreasing the amount of available calories.
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PMID:Malnutrition and malabsorption after total gastrectomy. A pathophysiologic approach. 279 31

Phosphorus is the sixth most abundant element in the body after oxygen, hydrogen, carbon, nitrogen, and calcium. It comprises about 1% of the total body weight of humans. Eighty-five percent of it is stored in the bone in the form of hydroxyapatite crystal; 14% is in the soft tissues in the form of energy-storing bonds with nucleotides (ATP, GTP), nucleic acids in chromosomes and ribosomes, 2,3-DPG in the red blood cells, and phospholipids in the cells' membranes. Less than 1% is in the extracellular fluids. Phosphate balance is maintained by multiple systems. The gut is responsible for the absorption of two thirds of the 4-30 mg/kg/day of phosphate intake. Absorption sites are all along the gut; in humans the most active site is the jejunum. The kidney filters 90% of the plasma phosphate and reabsorbs it in the tubuli. In states of hypophosphatemia the kidney can reabsorb the filtered phosphates very efficiently, reducing the amount excreted in the urine virtually to zero. The healthy kidney can excrete high loads of phosphate and rid the body of phosphate overload. Through the vitamin D-PTH axis the endocrine system regulates the phosphate balance by influencing the kidney, gut, and bone. Other hormones, including thyroid, insulin, glucagon, glucocorticosteroid, and thyrocalcitonin, play a lesser role in regulation of phosphate metabolism. Because of the complex control of phosphate homeostasis, various clinical conditions may lead to hypophosphatemia. These include nutritional repletion, gastrointestinal malabsorption, use of phosphate binders, starvation, diabetes mellitus, and increased urinary losses due to tubular dysfunction. The clinical picture of phosphate depletion is manifested in different organs and is due mainly to the fall in intracellular levels of ATP and decreased availability of oxygen to the tissues, secondary to 2,3-DPG depletion. The various manifestations of phosphate depletion are listed in Table 2. The treatment of hypophosphatemia consists of administering enteral or parenteral phosphate salts. An important aspect of dealing with the potentially serious effects of phosphate depletion is to prevent the depletion from happening in the first place. Hyperphosphatemia can occur in renal failure, hemolysis, tumor lysis syndrome, and rhabdomyolysis. The treatment of hyperphosphatemia usually consists of fluid administration (in the absence of kidney failure). In chronic hyperphosphatemia, phosphate binders such as aluminum and magnesium salts can reduce the phosphate load. The use of these phosphate binders is limited by their potential side effects.
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PMID:Consequences of phosphate imbalance. 306 Jan 61

Although various etiologic factors have been implicated, the mechanism responsible for bile acid malabsorption in CF remains unknown. Eight CF children studied twice on a normal diet supplemented with pancreatic enzymes and once during a one-month period of Vivonex administered by continuous nasogastric infusion were compared to age-matched controls. On the fat and residue-free elemental diet, there was a modest decrease in steatorrhea and no change in the daily excretion of nitrogen and neutral sterols. However, normalization of bile acid output (485.6 +/- 65.0 to 160.6 +/- 29.2 mg/24 hr) to control levels (150.2 +/- 60.7) was noted. Diminished microbial degradation of both neutral and acidic sterols and a smaller amount of bile acids adsorbed to decreased residues were also found. The data do not support the possibility of a bile acid ileal transport defect and suggest that the most important single factor responsible for the intraluminal sequestration of bile acids in CF is dietary residues. Because of significant ongoing losses of nitrogen and lipids, pancreatic enzymes should be given to CF patients on elemental diets.
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PMID:Effect of dietary fat and residues on fecal loss of sterols and on their microbial degradation in cystic fibrosis. 308 44

Some infants with biliary atresia obtain dramatic improvement for prolonged periods after the performance of hepatic portoenterostomy. Such infants may have life styles not substantially different from those of normal children. In others, the benefit from this operation, if any, is short lived. These infants are very vulnerable to the debilitating effects of severe, prolonged malabsorption and ultimately require orthotopic liver transplantation to sustain life. The physician caring for infants awaiting liver transplantation can do much, not only to prolong survival but to maintain satisfactory growth and development. The key consideration is to provide adequate nitrogen and nonnitrogen calories, liberally utilizing modern methods of enteral alimentation when necessary. In addition, attention must be directed toward several vitamin and mineral deficiencies, particularly those of the fat-soluble vitamins, that inevitably accompany severe malabsorption in children. Management of extrahepatic biliary atresia in infants is difficult and requires meticulous attention to details. Nevertheless, the long-term cure of this disorder provided by liver transplantation makes their care a rewarding experience.
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PMID:Nutritional support for the infant with extrahepatic biliary atresia. 310 6

Lipids are an essential component of our body composition and necessary in our daily food intake. Conventional fats and oils are composed of glycerides of long chain fatty acids and are designated as long chain triglycerides (LCT). Body fat as well as the fats and oils in our daily intake fall into this category. In enteral and parenteral hyperalimentation, we can identify such LCT fats and oils. Soy, corn, safflower and sunflowerseed oils are typical of the LCT oils. In the search for alternative noncarbohydrate fuels, medium chain triglycerides (MCT) are unique and have established themselves in the areas of malabsorption syndrome cases and infant care and as a high energy, rapidly available fuel. Structure lipids with a MCT backbone and linoleic acid built into the triglyceride molecule have been developed to optimize the triglyceride structure that is best for patients, particularly the critically ill. Structured lipids with built-in essential fatty acid components or other polyunsaturated fatty acids promise greater flexibility in patient care and nitrogen support.
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PMID:Medium chain triglycerides and structured lipids. 311 86


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