Overview
Pancreatic malabsorption involves impaired nutrient absorption due to defects in the passage of nutrients into the bloodstream, often resulting from conditions like exocrine pancreatic insufficiency (EPI), coeliac disease, and small intestinal disorders 12.Diagnosis
Clinical History: Essential for identifying risk factors and potential causes 12.
Endoscopy with Biopsies: Useful for diagnosing structural abnormalities and specific enteropathies 12.
Non-Invasive Functional Tests: Include breath tests and serological markers 12.
Radiological Imaging: Helps assess anatomical abnormalities and complications 12.
Faecal Fat Excretion: Gold standard for quantifying fat malabsorption, though practices vary widely 3.
Specific Indications: Suspected steatorrhoea, chronic diarrhea, unexplained weight loss 3.
Consider CD Screening: Particularly in cases with no clear etiology and high-risk individuals 12.Management
Nutritional Support: Oral supplements, enteral feeding, and tailored dietary modifications 12.
Pancreatic Enzyme Replacement Therapy (PERT): For EPI, typically with lipase at doses adjusted to dietary fat intake 1.
Address Underlying Causes: Treat specific conditions like CD with appropriate therapies 12.
Medication Management: Adjust medications that may influence malabsorption or stool characteristics 3.
Supportive Care: Includes hydration, electrolyte balance, and symptom management 2.Special Populations
Elderly Patients: High index of suspicion required due to varied presentations 4.
Comorbidities: Consider impact on diagnosis and management complexity 4.Key Recommendations
Early recognition and tailored diagnostic work-up are crucial for identifying the cause of malabsorption (Evidence: Strong 12).
Faecal fat excretion testing should be utilized judiciously, considering clinical context and proper patient preparation (Evidence: Moderate 3).
Nutritional support should be individualized, incorporating oral supplements or enteral feeding as needed (Evidence: Expert opinion 12).
Coeliac disease screening is essential in cases of unexplained malabsorption (Evidence: Strong 12).References
1 Lenti MV, Hammer HF, Tacheci I, Burgos R, Schneider S, Foteini A et al.. European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN. Part 1: Definitions, Clinical Phenotypes, and Diagnostic Testing for Malabsorption. United European gastroenterology journal 2025. link
2 Lenti MV, Hammer HF, Tacheci I, Burgos R, Schneider S, Foteini A et al.. European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN: Part 2: Screening, Special Populations, Nutritional Goals, Supportive Care, Primary Care Perspective. United European gastroenterology journal 2025. link
3 Lust M, Nandurkar S, Gibson PR. Measurement of faecal fat excretion: an evaluation of attitudes and practices of Australian gastroenterologists. Internal medicine journal 2006. link
4 Hossain J, Lewis RR. Malabsorption in the elderly. 1: Examination, history and investigation. Hospital medicine (London, England : 1998) 1998. link
5 Garg P, Parashar S. Pancreatic abscess due to Salmonella typhi. Postgraduate medical journal 1992. link
6 Malangoni MA, Richardson JD, Shallcross JC, Seiler JG, Polk HC. Factors contributing to fatal outcome after treatment of pancreatic abscess. Annals of surgery 1986. link