Malabsorption syndrome with IgG(lambda) M component: response to chemotherapy.

A patient with malabsorption syndrome and steatorrhea was found to have IgG (lambda) M component in the blood and some extracellular deposition of IgG in the intestinal wall. There was no evidence of multiple myeloma. He responded favourably to intermittent courses of melphalan and prednisone.     

Suitability of the azocoupling reaction with 1-naphthyl-beta-D-glucoside for the histochemical demonstration of lactase (lactase-beta-glucosidase complex) in human enterobiopsies.

The suitability of the simultaneous azocoupling reaction with 1-naphthyl-beta-D-glucoside and hexazonium-p-rosanilin in the detection of the activity of lactase (or lactase-beta-glucosidase complex) in jejunal biopsies of patients with various forms of the malabsorption syndrome was tested. Results were compared with those obtained with the indigogenic method using 4-Cl-5-Br-3-indolyl-beta-D-fucoside which is the method of choice. Both methods gave identical results as far as the relative intensity of the brush border staining was concerned. The azocoupling method applied in unfixed cold microtome sections can be recommended for the routine diagnostics of the malabsorption syndrome when the indolyl substrate is not available.     

The influence of experimentally induced pathological states on the flow and composition of central lymph in the rat

The flow of central lymph in the rat was examined and its concentration of total proteins was determined. Experiments were performed both on healthy animals and on animals with experimentally induced pathological states. The following results were obtained: The flow of the lymph is increased in chronic liver damage, acute kidney damage and the malabsorption syndrome. On the other hand, lymph flow is decreased in fasting animals, and it is unaffected by acute liver damage. Total protein concentration was increased in fasting rats and in the group with acute liver damage, and on the contrary, it was decreased in the group with chronic damage, acute kidney damage, and malabsorption syndrome. The lymph flow or total protein concentration are not sex-dependent.     

The comprehensive diagnosis of changes in the stomach and small intestine in patients with chronic colitis

Combined investigation of 121 patients with chronic colitis (CC) has shown chronic gastroduodenitis in 90.9% and the intestinal malabsorption syndrome in all the patients. Comparison of the frequency of intestinal malabsorption symptoms has shown that they are less marked in CC than in chronic enterocolitis with predominant intestinal lesion.     

A Comparison of Laboratory Tests in the Malabsorption Syndrome

Absorption of radioiodinated triolein was tested in 93 individuals (15 controls, 28 cases of functional diarrhea, and 50 patients with suspected or manifest malabsorption syndrome).The results so obtained were compared in 59 cases with estimations of fecal radioactivity and chemically determined fecalfat excretion. A highly significant correlation was found.The urinary xylose excretion test was performed in 96 individuals. The diagnostic value of the radioactive fat absorption test was compared with that of the xylose excretion test in 78 cases. Both tests were diagnostic in cases of non-tropical sprue, but the xylose excretion test reflected the clinical improvement more accurately in treated cases. The radioactive fat absorption test was more reliable in the diagnosis of malabsorption secondary to bowel resection than was the xylose excretion test, but the converse was true in the diagnosis of malabsorption secondary to gastrectomy. The simultaneous use of these two tests was found to be a simple and reliable screening procedure.     

A case of fatal malabsorption syndrome caused by strongyloidiasis complicated with isosporiasis and human cytomegalovirus infection]

This 54-year-old Korean coal miner suffered from continuous watery diarrhea and weight loss after corticosteroid treatment (beta-methasone, 4 mg daily for 1 week) due to hip-bone fracture in January 1991. Except for the short therapy of steroid, no other histories were contributory. The malabsorption syndrome was aggravated while the case was treated under the impression of amebiasis or intestinal tuberculosis. AIDS antibody test by EIA was negative and quantitative analysis of serum immunoglobulins was in normal ranges. Nine months after the onset of symptoms, the case was diagnosed as malabsorption syndrome caused by complexed and aggravated infection by Strongyloides stercoralis, Isospora and cytomegalovirus in the small intestine, which were proved by stool examination and duodenal biopsy. His clinical course became worse even after high-dosed and prolonged albendazole treatment for strongyloidiasis with supportive fluid therapy. The patient was discharged in hopeless status in November, 1991 and died after one week at home.     

Oxalate nephropathy due to gastrointestinal disorders.

Renal failure secondary to oxalate interstitial nephritis developed in three patients with malabsorption and steatorrhea following a jejunoileal bypass, extensive small intestine resection and a partial gastrectomy. Hyperoxaluria was documented in two of the cases. The possibility that this complication can occur in patients after a jejunoileal bypass operation is now recognized. This report shows that it can also occur in patients with other bowel disorders that cause malabsorption and steatorrhea. Since the prognosis for patients with oxalate nephropathy is poor, renal function should be closely monitored in patients who are at risk because of these disorders. Therapy should be directed at correcting malabsorption, steatorrhea and hyperoxaluria. When the renal function of patients with a jejunoileal bypass continues to decline despite intensive medical therapy, restoration of bowel continuity is strongly recommended.     

Is bile acid malabsorption underdiagnosed? An evaluation of accuracy of diagnosis by measurement of SeHCAT retention.

The cause of intractable chronic diarrhoea was found to be malabsorption of bile acid in five out of 42 patients thought to have the irritable bowel syndrome, six out of 29 patients with persistent diarrhoea after surgery for peptic ulcer, 23 who had undergone small bowel resection, and two others. Specific treatment brought symptomatic relief. The diagnosis was established by measuring the proportion of SeHCAT, a synthetic bile salt, retained one week after oral administration of a tracer dose of less than 100 micrograms of the compound labelled with 40 kBq (1 microCi) of selenium-75. These results indicate that malabsorption of bile acid is a more common cause of chronic diarrhoea than is generally appreciated. Measurement of retention of SeHCAT is a simple, accurate, and acceptable means of establishing the diagnosis of this debilitating but treatable condition.     

Delayed puberty in an 18-year-old female patient with late diagnosis of celiac disease

A case of a 18-year female patient is presented. The patient suffered from certain symptoms of malabsorption syndrome. She was also retarded sexually. Celiac disease was diagnosed according to ESPGAN criteria. Gluten -free diet produced body weight increase, pain relief, improved well-being and normal menstruation.     

Digestive Efficiency Mediated by Serum Calcium Predicts Bone Mineral Density in the Common Marmoset (Callithrix jacchus)

Two health problems have plagued captive common marmoset (Callithrix jacchus) colonies for nearly as long as those colonies have existed: marmoset wasting syndrome and metabolic bone disease. While marmoset wasting syndrome is explicitly linked to nutrient malabsorption, we propose metabolic bone disease is also linked to nutrient malabsorption, although indirectly. If animals experience negative nutrient balance chronically, critical nutrients may be taken from mineral stores such as the skeleton, thus leaving those stores depleted. We indirectly tested this prediction through an initial investigation of digestive efficiency, as measured by apparent energy digestibility, and serum parameters known to play a part in metabolic bone mineral density of captive common marmoset monkeys. In our initial study on 12 clinically healthy animals, we found a wide range of digestive efficiencies, and subjects with lower digestive efficiency had lower serum vitamin D despite having higher food intakes. A second experiment on 23 subjects including several with suspected bone disease was undertaken to measure digestive and serum parameters, with the addition of a measure of bone mineral density by dual‐energy X‐ray absorptiometry (DEXA). Bone mineral density was positively associated with apparent digestibility of energy, vitamin D, and serum calcium. Further, digestive efficiency was found to predict bone mineral density when mediated by serum calcium. These data indicate that a poor ability to digest and absorb nutrients leads to calcium and vitamin D insufficiency. Vitamin D absorption may be particularly critical for indoor‐housed animals, as opposed to animals in a more natural setting, because vitamin D that would otherwise be synthesized via exposure to sunlight must be absorbed from their diet. If malabsorption persists, metabolic bone disease is a possible consequence in common marmosets. These findings support our hypothesis that both wasting syndrome and metabolic bone disease in captive common marmosets are consequences of inefficient nutrient absorption. Am. J. Primatol. 75:153‐160, 2013. © 2012 Wiley Periodicals, Inc.     

A method for obtaining a long-lived intestinal tissue culture

The interest in the studies of the intestines using the method of tissue organ culture has considerably grown in recent years. It can be explained by the great possibilities of obtaining unique data about the state of intestines in normal and pathological condition, e.g. malabsorption syndrome. The paper deals with the method modified by the authors to obtain long-living (24 hours) intestinal tissue organ culture. The investigations used bioptic sections which were obtained by jejunoscopy with spot biopsy of children suffering from intestinal malabsorption. The viability of the explants was proved by histological and histochemical tests. The promise held by the methods is emphasized.     

Hematological and Biochemical Analyses of Blood and Serum in Pigs with Regional Ileitis with Special Reference to the Pathogenesis

Biochemical and hematological analyses of blood and serum were performed in pigs with regional ileitis and in wasting pigs with a negative necropsy. In sera from pigs with regional ileitis the levels of total protein, albumin, transferrin, alkaline phosphatase and zinc were significantly decreased compared with normal pigs of the same age. The number of white blood cells, and the concentration of Cortisol and α1-antitrypsin were significantly increased. In wasting pigs with early signs of regional ileitis or with a negative necropsy the same blood changes were observed but to a less degree. It was concluded that a wasting syndrome after weaning may precede regional ileitis. Concerning the etiology of regional ileitis the significance of malabsorption and wasting syndrome in combination with invasion of intestinal intercellular microorganisms is discussed.     

Restless Legs Syndrome,with Particular Reference to its Occurrence After Gastric Surgery

There is a higher incidence of restless legs syndrome (Ekbom''s syndrome) in patients after gastric surgery (11·3%) and with diabetes mellitus (17·0%) and uraemia (17·3%) than in patients who have been diagnosed as having a psychonoeurosis (4·0%) and in controls (2·0%). Three patients with malabsorption syndrome complained of restless legs, but these patients had abnormal neurological signs. The incidence after gastric surgery and in diabetes mellitus and uraemia remained high even when patients with any abnormal neurological signs were excluded.     

Sucrose Malabsorption in Greenland

In a population study on the western coast of Greenland the incidence of sucrose malabsorption was estimated by means of sucrose tolerance tests in 190 persons. Small-intestinal disaccharidase activity was estimated in 19 patients. Sucrose malabsorption was present in 10·5% of the cases studied—a surprisingly high figure and much higher than the incidence reported elsewhere in the world. This incidence is, however, lower than that of lactose malabsorption in Greenland Eskimos (54%). In contrast to lactose malabsorption, sucrose malabsorption is present from birth; this may have important clinical implications since chronic diarrhoea and malnutrition are fairly common during infancy in Greenland.     

Systemic lupus erythematosus

Imerslund-Gräsbeck syndrome (IGS) or selective vitamin B₁₂ (cobalamin) malabsorption with proteinuria is a rare autosomal recessive disorder characterized by vitamin B₁₂ deficiency commonly resulting in megaloblastic anemia, which is responsive to parenteral vitamin B₁₂ therapy and appears in childhood. Other manifestations include failure to thrive and grow, infections and neurological damage. Mild proteinuria (with no signs of kidney disease) is present in about half of the patients. Anatomical anomalies in the urinary tract were observed in some Norwegian patients. Vitamin B₁₂ absorption tests show low absorption, not corrected by administration of intrinsic factor. The symptoms appear from 4 months (not immediately after birth as in transcobalamin deficiency) up to several years after birth. The syndrome was first described in Finland and Norway where the prevalence is about 1:200,000. The cause is a defect in the receptor of the vitamin B₁₂-intrinsic factor complex of the ileal enterocyte. In most cases, the molecular basis of the selective malabsorption and proteinuria involves a mutation in one of two genes, cubilin (CUBN) on chromosome 10 or amnionless (AMN) on chromosome 14. Both proteins are components of the intestinal receptor for the vitamin B₁₂-intrinsic factor complex and the receptor mediating the tubular reabsorption of protein from the primary urine. Management includes life-long vitamin B₁₂ injections, and with this regimen, the patients stay healthy for decades. However, the proteinuria persists. In diagnosing this disease, it is important to be aware that cobalamin deficiency affects enterocyte function; therefore, all tests suggesting general and cobalamin malabsorption should be repeated after abolishment of the deficiency.     

The response of skeletal muscle to alcohol abuse: Gender differences

A gender analysis has been carried out to analyze changes in intracellular signaling pathways that lead to the development of chronic alcoholic myopathy. It is known that acute or chronic alcohol intoxication can result in alcohol-induced lesions in skeletal muscles. Chronic alcoholic myopathy occurs much more frequently and can develop either independently or in combination with other forms of alcoholic disease (liver and heart lesions, malabsorption syndrome, or alcohol polyneuropathy). This disease is manifested by atrophy of skeletal muscles and a performance decrement. Most of the studies on the pathogenesis of chronic alcoholic myopathy have been carried out on male patients. Studies on alcoholic myopathy-induced muscle damage in females have not been previously reported.     

The Role of the Upper Gastrointestinal Flora in the Malabsorption Syndrome

Bacterial contamination of the upper gastrointestinal tract by colonic flora appears important in the production of some forms of secondary steatorrhea. Gastric contents have been studied in patients with normal intestinal absorption and with malabsorption syndrome. In secondary steatorrhea there is a significantly increased incidence of gastric contamination by colon organisms, and this is usually associated with absence of free hydrochloric acid. It seems probable that such contamination interferes with intestinal digestion and absorption. The benefit resulting from the oral administration of broad-spectrum antibiotics to a group of patients with secondary steatorrhea supports this concept.     

Gluten-sensitive enteropathy in a cynomolgus monkey

A malabsorption syndrome was observed in a cynomolgus macaque. Clinical signs included weight loss despite increased appetite, and diarrhea, characterized by an increased volume of soft, tan, malodorous feces. Clinicopathologic findings included hypoalbuminemia, generalized dilation of bowel loops with a prolonged transit time, steatorrhea and markedly diminished absorption of D-xylose. Biopsies of the duodenum and jejunum had total villous atrophy, crypt hyperplasia and a plasmacytic-lymphocytic infiltrate of the lamina propria. The monkey's diet was changed to a semi-synthetic diet containing no grain products. Subsequently, stool characteristics, body weight and intestinal villous morphology returned to normal. This response to removal of grain products from the diet suggests a syndrome similar to gluten-sensitivity enteropathy in human beings.     

Intraluminal Precipitation of Bile Acids in Stagnant Loop Syndrome

The postprandial concentrations of free and conjugated bile acids were measured in total content and micellar phase of jejunal aspirates from nine patients with steatorrhoea due to the stagnant loop syndrome and from 11 normal controls. Aspirates from the stagnant loop syndrome patients, but not from the normal controls, had a high concentration of free (unconjugated) bile acids. There was a reciprocal decrease in the concentration of conjugated bile acids, but total bile acid concentration in the whole aspirate remained normal. Total bile acid concentration in the micellar phase of intestinal content was reduced, indicating precipitation of bile acids. These findings suggest that precipitation of unconjugated bile acids, rather than passive absorption, leads to a reduced postprandial concentration of bile acids in the micellar phase of jejunal content, and are consistent with the hypothesis that fat malabsorption in the stagnant loop syndrome results from decreased micellar dispersion of lipolytic products.     

Pellagra.

Pellagra due to malnutrition occurred in an Ottawa women in 1973. She was given a normal diet with supplements of riboflavin, thiamine, niacin and ascorbic acid. The clinical response was striking. Although pellagra is still common in some parts of the world, it is now rare in North America. The disease may occur secondary to malnutrition or malabsorption; inborn errors of metabolism or transport, as in Hartnup disease; deviation of precursors of niacin, as in carcinoid syndrome; or competitive inhibition of niacin incorporation into nicotinamide-adenine dinucleotide, as with administration of isoniazid.