Therapy of the
malabsorption syndrome centers on adequate diagnosis of the underlying pathology, with vigorous therapeutic efforts directed at correcting this and thereby preventing ongoing losses of nutrients. Dietary
therapy includes a high-
protein, high-calorie,
low-fat diet often supplemented with MCTs in an effort to minimize
steatorrhea. Water-soluble
vitamin deficiency is rare, but supplementation with small daily doses is innocuous and probably should be prescribed. Significant fat-soluble
vitamin deficiencies are seen more commonly and can be monitored by physical examination and the prothrombin time.
Calcium,
magnesium, and
vitamin D deficiencies are more common than originally suspected. Adequate
therapy requires monitoring of the serum
calcium,
magnesium,
parathyroid hormone levels, and, optimally, 24-hour urinary collections for
calcium. Supplementation of these
mineral deficiencies requires ongoing close observation to prevent
hypercalcemia.
Iron deficiency can be easily diagnosed by available serum
iron determination, and replacement with oral supplements is curative. Trace
metal deficiencies occur, but our capabilities of detecting and treating them is still in its infancy. Figure 3 outlines our approach to the evaluation and treatment of the patients suspected of having the
malabsorption syndrome.