Kingdom of Saudi Arabia

Taibah University – Madinah

College of Applied Medical Sciences
Department of Clinical Laboratory Sciences

Student : Ahmad Khalaf Alsaedi

Student number : 3701447
Supervisor : Ahmad Mohamed
Clinical biochemistry
MLT 411
 Best Practice & Research Clinical Gastroenterology

Paper Title: Assessment of intestinal malabsorption .

Authors : K. Nikaki, Medical Degree, MRCPCH, Clinical Research Fellow, G.L. Gupte, MD (Paeds
India), DNB (Paeds India), MRCPI, Consultant Paediatric Hepatologist .

Hypothesis : Tests that uses these days are not accurate to investigate intestinal malabsorption in
patient .

Aims : To summarize The current clinically available methods and research tools that used to
investigate intestinal malabsorption in order to figure out which test is more accurate .

Introduction : The examination of intestinal malabsorption is guided by the clinical introduction

and discoveries. Normal digestion might be divided in the intraluminal stage, mucosal stage and
post-absorptive stage . During the intraluminal stage, the pancreatic and biliary secretions hydrolyse
and solubilise the dietary fats, carbohydrates and proteins . Fat malabsorption is a cardinal
indication of these disorders. During the mucosal stage, the brush border enzymes assume an
essential job in the hydrolysis of the disaccharides and peptides. Primary mucosal disorder, extensive
intestinal resection and lymphomas result in malabsorption of all nutrients. During the post-
absorptive stage, lymphatic system obstruction may cause a steatorrheoa and protein loosing
enteropathy.

Results: The result shows there are many levels of investigations for intestinal malabsorption.

 First Level of investigations include :

A) Blood test is consider as screening test and include : 1- Full blood count, Blood film 2- Renal
function 3- Bone profile 4- Liver Function Tests (incl. Albumin and INR) 5- Thyroid
Function Tests 6- Coeliac serology 7- CRP/ESR .
B) Stool tests is consider screening test and include : 1- Stool microscopy and culture 2- Stool
for ova, cysts and paracytes 3- c. difficile 4- Faecal occult blood test 5- Faecal Calprotectin .

 Second level of Investigations is more specific than first level and include :
A) Blood test : 1- Vitamin levels (Vit A, D, E, B12) 2- Serum elements (Mg, Zn, Se, Cu,
Mn) 3- Iron studies 4- Lipid studies .
B) Stool test : 1- Stool pH and reducing substances 2- Faecal fat globules 3- Faecal alpha1
antitrypsin (a1-AT) 4- Faecal elastase.

 Thired level of Investigations:

A) Endoscopy : 1- Duodenal biopsies 2- Terminal ileum biopsies 3- Jejunal aspirate for
culture.
B) Imaging : 1- Abdominal USS and Xray 2- CT abdomen 3- Barium meal and follow
through.
 Fourth level of Investigations which is highly specific : 1- Hydrogen breath test, ± Lactose
tolerance test, ± Urine galactose 2- Genetics for CHO malabsorption 3- Serum D-lactate 4-
Best Practice & Research Clinical Gastroenterology
13C- mixed-chain triglyceride breath test 5- SeCHAT, ± Serum C4 6- Schilling test (with and
without intrinsic factor) 7- VCE 8- Technitium-99m human serum albumin scintigraph

Conclusion : Investigating the small bowel's absorption is is a fascinating and important not
exclusively to gastroenterologists but all specialists, as nutrition assumes a significant job on
results in all fields of medication. The clinical calculation for exploring intestinal
malabsorption relies upon whether every single supplement pathways are influenced or not.
The methods that are right now accessible are indirect methods of assessing the various
pathways of nutrient absorption. The quest for minimally invasive, specific and sensitive
methods is still on. This turns out to be much increasingly significant as progressively
pediatric patients with short bowel syndrome survive and reach at adulthood. In addition,
small bowel transplantation is advancing and gets established in pediatric and grown-up
patients.

https://www.sciencedirect.com/science/article/abs/pii/S1521691816000196