Malabsorption syndrome

holistic approach towards malabsorption
introduction and naturopathic approach towards syndrome

1. Malabsorption syndrome By Divya Chandil BNYS IV year

2. Introduction

3. Introduction It is defective absorption and transport of digested macro and micronutrients in the body. This will result in : Maldigestion True malabsorption

4. Maldigestion :- impaired breakdown of nutrients to absorbable split products. Malabsorption :- defective mucosal uptake and transport of adequately digested nutrients including vitamins and trace elements. Malabsorption syndrome (MAS):- it is a clinical term that encompass defects occurring during the digestion and absorption of food nutrients by gastrointestinal tract.

5. it may affect Broad range individual/group Of nutrients of nutrients Pan specific Malabsorption malabsorption

6. Epidemiology It is common gastroenterology practice in tropics including India. Celiac disease is frequently reported as cause of MAS in children and adult. It was once known as tropical spure in south Indian villages.

7. Classifications It classify directly or indirectly based on the causes. Causes: Maldigestion malabsorption mucosal abnormality syndrome Bacterial contamination

8. Physiology Digestion involve both mechanical and enzymatic breakdown of food. Majority digestion occur in small intestine. jejunum is major site for absorption of most of nutrients except: Ions absorbed in duodenum. Vit b12 and bile salts in ileum Water and lipid throughout the small intestine.

9. Causes 1. Digestive failure due to - pancreatic insufficiencies - bile salt insufficiencies 2. Structural defects - gastrectomy, gastro- jejunostomy - fistulae , diverticulae short bowel syndrome 3. Mucosal abnormality - coeliac disease

10. 4. Enzyme deficiencies - lactose intolerance - disaccharides deficiency - enteropeptidases deficiency 5. Due to infective agents - whipple’s diseases - intestinal TB - tropical sprue - parasites 6. Due to other systemic diseases affecting GIT - hyper or hypothyroidism - DM - hyper or hyperparathyroidism - malnutrition

11. Pathogenesis

12. All theses causes Disturb interaction between Secretary, motor, and absorptive function Leading to

13. Pathological interference with Digestion ( intraluminal process) Absorption ( mucosal process) Transport ( post mucosal events) Results in MALABSORPTION

14. Disturbed intestinal transit and SI bacterial overgrowth : Ileal brake mechanism in transit small amount nutrient passed to colon without getting absorbed which act as energy source of colonic bacteria exert regulatory mainly inhibitory affect on upper GI function

15. Rapid intestinal transit high osmotic load increased bacterial metabolism disturb regulatory mechanism Delayed intestinal transit promote SI bacterial overgrowth De-conjugation of bile acid due to enzymes affect bile acid absorption thus disturb lipid absorption

16. Sign & Symptoms mainly depends on underlying pathology. Common symptoms include: -weight loss -Chronic diarrhea -Steatorrhea -flatulence -Anorexia -Fatigue -Anaemia -Bone fragility -Edema etc.

17. Diagnostic Approach To Malabsorption

18. suspecting presence of malabsorption – history and physical examination. confirming its existence- hematological, biochemistry, and absorption testing. evaluating for the cause.

19. Diagnosis Done on basis of signs and symptoms. BLOOD TEST & BIOCHEMICAL TEST -- to reveal Anemia -> microcytic or macrocytic. Cholesterol or TG levels ->fat malabsorption. Calcium &phosphate level ->(osteomalacia) low vit D absorption. Fat soluble vitamins are affected in fat malabsorption. Prolonged prothrombin time -> vit K deficiency. Specific vitamin or micronutrients level check. ATG- Abs or anti- endomysial Abs -> celiac disease

20. STOOL STUDIES microcytic examination -> reveal parasite, ova, cysts, and other infective agents. low fecal pancreatic elastase –> pancreatic insufficiency Trypsin & chemotrypsin can be assessed. RADIOLOGOCAL STUDIES: barium follow or barium enema CT abdomen.

21. INTERVENTIAL STUDIES oesophago-gastroduodenoscopy Enteroscopy Colonoscopy VCE (video capsule endoscopy) ERCP ( endoscopic retrograde cholangiopancreatography) Other test Schilling test -> vit B12 malabsorption D- xylose test Lactose tolerance test Qualitative and Quantitative fecal fat analysis

22. Naturopathy understanding of malabsorption

23. Aim of treatment Eliminating toxins from body complete rest to enhance self healing 3. diet and yoga as healing tools

24. Toxin elimination Eliminative diet hydro treatment like enema, cold hip bath, abdominal pack or mud pack to abdomen neem enema other- full mud bath, sun bath, steam bath This give sudden relief from all severe symptoms.

25. Complete rest of both body and mind fasting according to severity after cleansing go for soothening diet constructive diet A healthy diet should comprise 2o% acidic and 80% alkaline food. Fiber, curd and gluten free diet help to restore gut bacteria. Balanced food is essential for healthy life.

26. Yoga: therapeutic tool Asanas - which compress and stretch abdomen 2. Pranayamas - nadi shodhana, Kapalbhati, bhastrika ( avoiding during severe IBD) - cooling pranayamas 3 . Kriyas - vamana dhauti and shankhaprakshalana shankhaprakshalana helps at mucosal level .it helps in removing the defective mucous layer, and after practice eating of khichdi help in regaining the health and corrects absorption process.

27. 4. Meditation - reduce stress and promote self healing Precautions :- avoid giving raw food in ulcers conditions, as it may worsen the condition. suggest any practice according to the conditions of patient.

28. Role of Counseling Educate patient to take healthy diet, daily exercise and positive thoughts Also advised how to deal with acute diseases in future so that healing will be complete.

29. Dosage in interventions health of digestive system is giver priority. complete nutritional supplements are necessary. hydro modality give with aim to assist inflammation. Treatment should be given for 15-30 days, followed by once a week for next 30 days.

30. Follow up measures constructive should be follow. Yoga practice should be regular naturopathy interventions till complete restoration of health.