Maldigestia( or a syndrome of digestive failure) is a whole complex of symptoms associated with the disruption of the process of splitting vital nutrients( nutrients) into components suitable for digestion, due to a lack of digestive enzymes and a number of other reasons.
Accompanying almost every pathology of the gastrointestinal tract, it sometimes manifests itself from the first days of life of newborns suffering from congenital pathologies. A close relationship between maldigestia and malabsorption syndrome was established( a chronic disorder of the processes of digestion, transport and absorption of nutrients in the small intestine).
Provoking malnutrition, maldigestia can become the culprit for not only a significant reduction in body weight, but also more serious physiological changes due to the fact that insufficiently digested food gruel( chyme) can become an excellent medium for the propagation of pathogenic microflora, as well as an inexhaustible source of a huge amountantigens, which give rise to the occurrence of allergic reactions.
Being a multi-stage process designed to turn complex nutrients into simpler, more digestible digestive systems, digestion plays a key role in it. That is why even minor violations of this process can significantly worsen the condition of the whole organism.
Maldegestia, accompanying most of the gastrointestinal diseases, in this context seems to be an extremely common and urgent problem. In older people, under the influence of inevitable age processes, maldigestia acquires a special - involutive - form.
Causes of the maldigestion syndrome
The factors provoking the appearance of maldigestia are extremely diverse: this explains the high prevalence of pathology in patients of any age.
Maldigestia syndrome is divided into three forms, represented by pathologies of intracellular, cavitary and parietal digestion. The cause of violations of the cavity digestion may be:
- Inadequate production of alkaline and digestive enzyme-rich pancreatic juice( referred to as exocrine pancreatic insufficiency) observed in certain pancreatic diseases presented by cystic fibrosis, chronic pancreatitis, fistula or cancer of this organ, and after surgical removal of pancreatic segments as a result of subtotal pancreatectomy.
- Inactivation( partial or total loss of activity) of digestive enzymes, occurring in the body of patients suffering from duodenal ulcer, Zollinger-Ellison syndrome, gastroduodenitis and dysbacteriosis( pathological change in the qualitative composition of the intestinal microflora) of the small intestine.
- Mixing of digestive enzymes with chyme and broken transit of intestinal contents observed in patients with diarrhea, irritable bowel syndrome, chronic intestinal pseudo-obstruction, stenoses of different parts of the intestine, as well as in conditions arising after performing draining surgical interventions and gastric vagotomy.
- Significant decrease in the concentration of digestive enzymes( due to their "dilution"), characteristic of small intestine dysbiosis, post-gastroectomy syndrome and a condition provoked by the operation of cholecystectomy( removal of the gallbladder).
- Reduction of the synthesis of the peptide hormone secretin and the neuropeptide hormone of cholecystokinin, produced by special cells of the small intestinal mucosa.
- Acute lack of bile acids, provoked by liver pathologies( primary biliary cirrhosis, biliary obstruction, hepatitis), diseases of the terminal section of the small intestine, small intestine dysbiosis, and cholestyramine therapy.
- Gastrogenic digestive deficiency that develops in patients with atrophic gastritis or after an operation consisting in removal( resection) of a part of the stomach.
- Because enterocytes, intestinal epithelial cells, their death or dystrophy due to gluten enteropathy, Crohn's disease, enteritis of different etiology and sarcoidosis, are responsible for the success of the membrane wall digestion, it can cause dysfunctional conditions of the gastrointestinal tract.
- The most common cause of impaired intracellular digestion is the acute deficit of disaccharidases( enzymes secreted by cells of the intestinal mucosa), caused by an enzymatic deficiency that is primary( congenital) or secondary( acquired) nature.
- Disturbances in the digestive process can be caused by an incorrect outflow of lymphatic fluid from the intestine due to obstruction of the lymphatic ducts. Similar pathologies are observed in patients suffering from lymphomas, intestinal tuberculosis, lymphangiectasia, carcinoid( carcinoid tumors) of the intestine.
- The development of maldigestion can be caused by a whole complex of disorders accompanying AIDS, hypogammaglobulinemia( a pathology due to B-cell deficiency against the background of a decrease in the size of immunoglobulins), hyperthyroidism( a condition caused by too active synthesis of thyroid hormones by the thyroid gland), diabetes mellitus, amyloidosis, leading to the deposition in tissues of protein-polysaccharide substances - amyloids), giardiasis and many other diseases.
- Drinking fermentation beverages( home wine, all kinds of kvass), as well as inadequate nutrition and excessive enthusiasm for diets can give impetus to maldigestion.
As a rule, it provokes a confluence of factors that do not give enough or even a little bit more digestive enzymes to be activated, or to properly contact the substrate.
Symptoms of
The main clinical symptom that accompanies any form of maldigestion is manifested by the presence of:
- diarrhea;
- bloating and his constant rumbling;
- increased gas production;
- belching;
- frequent nausea;
- abdominal pain.
The severity of the above dyspeptic phenomena increases by the second half of the day, because the digestive process at this time is the most intense. Not less characteristic signs of maldigestia should be considered a significant deterioration in appetite, a feeling of weakness and a decrease in body weight.
It has been established that manifestations of maldigestia are much brighter in young patients;in adults, as a rule, it reminds of itself only the appearance of insignificant digestive disorders.
When maldigestia is also observed:
- a significant increase in the amount of feces, accompanied by a change in their odor and color;
- presence of steatorrhea;
- intolerance of certain foods( the causes and clinical manifestations of this phenomenon will be described in the section on types of fermentopathy).
Maldigestia, taking place in severe form, provokes a sharp deterioration in the general condition caused by poor absorption of insufficiently split nutrients and fraught with the development of another digestive pathology - malabsorption syndrome.
For these patients is characterized by:
- rapid weight loss;
- apathetic condition;
- sensation of strong weakness;
- deterioration of appearance, manifested in severe dry skin, brittle hair and nail plates;
- is a disorder of the menstrual cycle.
Types of
Fermentopatii with maldigestii are congenital and acquired. Congenital ailments are presented:
- Insufficiency of disaccharidases - special intestinal enzymes( isomaltase, lactase, saccharidase), which provide digestion of disaccharides( the most common compounds of this group of carbohydrates are lactose, maltose and sucrose).Disaccharidase-deficient enteropathies manifest themselves by the appearance of disturbances accompanying the digestion of products containing the above disaccharides. The most striking example of such fermentopathy is the intolerance of milk and dairy products, due to the lack of lactase in the human body. Since lactose is the main component of any( including maternal) milk, therapy of severe forms of lactase deficiency in infants, manifested from the first days of their life, is extremely difficult task. With the use of milk and products containing it, in any person with lactase deficiency, bloating, the appearance of watery foamy diarrhea and uncomfortable sensations in the intestine are observed. It has been established that with age, the activity of lactase significantly decreases even in initially healthy people.
- Deficiency of peptidase. In the medical literature this congenital pathology is called celiac disease or gluten enteropathy. The main cause of digestive disorders in celiac disease is damage to intestinal villi - special suction organs - by a number of food products containing gluten and related proteins found in cereal crops: rye, oats, wheat, barley. The defeat of the villi leads to the appearance of chronic diarrhea and steatorrhea - a pathology consisting in the allocation of a large amount of fat to the calves.
- Insufficiency of enterokinase. The main purpose of this digestive enzyme is to convert the proenzyme of trypsinogen into a trypsin enzyme. Deficiency of enterokinase may jeopardize the success of the digestive process, since trypsin, which is part of the pancreatic juice in the form of trypsinogen, can remain in the non-activated state. The consequences of this rather rare congenital anomaly can be prevented if, after a timely diagnosis, an adequate treatment consisting of adherence to a special diet and the appointment of substitution therapy will be started in the first weeks of the life of the newborn. The main clinical manifestations of enterokinase deficiency are: severe developmental anomalies, hypotrophy( chronic pathology of digestion and nutrition in young children, characterized by depletion), vomiting, diarrhea.
The group of purchased fermentopathies includes:
- Cases of alimentary fermentopathy, which develops as a result of poor nutrition, characterized by an imbalance in the ratio of nutrients( fats, proteins, carbohydrates, macro- and microelements) in the food intake and often resulting in protein starvation. The only way to correct this pathology is to normalize nutrition.
- Anomalies characterized by insufficient digestion of food in the stomach caused by insufficient production of hydrochloric acid, preparing food for the passage of further stages of digestion.
- Pathologies of digestion, arising from intestinal diseases: Crohn's diseases, chronic enteritis, and also conditions that develop after the operations on the small intestine. Each ailment is characterized by a separate complex of clinical manifestations.
- Diseases of the digestive system.
- Digestive disorders caused by the use of some medications: for example, antibiotics, which can provoke the development of intestinal dysbiosis. Equally strong influence on the intestinal microflora can be provided by cytostatics and radiotherapy sessions used for the treatment of oncological diseases.
- Cases of involutional maldigestia caused by the inevitable effect of age-related changes occurring in the intestines of the elderly. Given the extreme deterioration of all body systems, a significant decrease in the secretion of digestive enzymes and hydrochloric acid, a weakening of intestinal peristalsis, the only way to alleviate the condition of elderly patients is taking substitute medications and switching to easily digestible food.
Diagnosis
The onset of anxiety symptoms is the basis for referring to a qualified gastroenterologist.
The state of the digestive function is evaluated using:
- The procedure for studying enzymatic activity on the mucous membranes of the digestive tract and in intestinal juice. The success of cavitary digestion depends on the activity of enzymes secreted by the pancreas( alpha-amylase, enterokinase, alkaline phosphatase, etc.).Pristenochnoe digestion is influenced by intestinal enzymes( represented by peptidase, disaccharidases, etc.).The concentration of enzymes is determined by the method of studying the washings taken from the small intestine. To assess the activity of enterocytes, a glycemic curve is constructed, aligned with the results of the disaccharide load of the patient's body. After the patient consistently ingested 50 g of maltose, sucrose and lactose, glucose concentration in his blood is measured, doing this after 15, 30 and 60 minutes. If the increase in its level in the blood did not occur - there is a lack of the corresponding enzyme in the body, confirming the presence of maldigestii.
- Biochemical blood test for monomer content. In the presence of pathology, the concentration of amino acids and monosaccharides in the patient's blood will be increased.
For the identification of maldigestia must be carried out:
- Coprological examination of stool, in the case of existing pathology revealing a high content of starch in them, insufficiently digested muscle fibers and inclusions of fat. A characteristic manifestation of maldigestia is steatorrhea, characterized by the presence of shiny, sticky and fatty stool. To determine its degree, perform a daily study of stool by the technique of Van de Camera.
- Bacteriological study of feces for dysbacteriosis, revealing the quantitative composition of microflora in the intestine.
- Procedure of endoscopic biopsy of the small intestine mucosa( to determine the degree of morphological changes that occurred in it).The specialist will notice whether there are areas of necrosis, atrophied or distrophysed tissues on them, whether the amount of intestinal villi has decreased, whether the blood flow has not been disturbed.
- Radiographic examination of the abdominal cavity.
- Radiography of the passage of barium through the lumen of the small intestine, helping to identify violations of the absorption process and features of intestinal motility. In general, radiological techniques in this case are used for the most part to exclude the possibility of cancer and organic diseases.
Treatment of
- The leading method of treatment of maldigestia is the nutrition of , the characteristics of which are determined by the type of the disease and the severity of its clinical course. With any variant of pathology, the use of sparing food containing many proteins, microelements and carbohydrates and only a small amount of fat is recommended. Products whose intolerance has been accurately identified are subject to mandatory exclusion from the diet. When maldigestii is also unacceptable, the use of raw fruits and vegetables.
- To adjust the absorption of nutrients, substitution therapy is used. Patients in whom the production of pancreatic enzymes is insufficient is prescribed medications( Mezim, Creon) containing these enzymes. If maldigestia was provoked by liver diseases, the patient is prescribed medications( "Pansinorm", "Enzistal", "Festal"), which include enzymes and bile components. To restore impaired intestinal peristalsis drugs are used( Imodium, Dicetel, Duspatalin), which help to regulate the motility of the digestive system.
- In order to get rid of the dysbacteriosis , always accompanying any digestive disorders, the patient should take intestinal antiseptics, antibacterial drugs and probiotics.
- To restore the integrity of the mucous membranes , enterosorbents and preparations with astringent action will help.
- To strengthen the body of a person suffering from maldigestion , he is given minerals and multivitamin complexes.
Despite the absence of specific prevention of this pathology, it can be prevented by healthy and proper nutrition, hygiene, timely diagnosis and treatment of digestive tract diseases.