How to approach the child suspected of malabsorption. Experience from a prospective investigation of suspected malabsorption in children 1968-1976 in Malmö.

Abstract

ABSTRACT. 180 children (mean age 20 months) suspected of malabsorption because of failure to thrive, abnormal stools more than 3 weeks, vomiting, an/or abdominal distension were investigated with peroral small intestinal biopsy at duodeno‐jejunal flexure (172 children) and/or duodenal intubation for analysis of trypsin and amylase activity in duodenal juice before and after a test meal of water (76 children). Results of xylose tolerance test, lactose tolerance test, faecal fat, B‐folate, S‐iron, and S‐albumin were related to morphology of mucosa. A normal finding of one of these tests means in 15–26% a normal mucosa (diagnostic sensitivity). An abnormal finding means in 40–85% a severely damaged mucosa and in 85–100% a slightly, moderately, or severely damaged mucosa (diagnostic specificity). Combinations of these tests increase the diagnostic sensitivity 10–15%. Faecal chymotrypsin seems to be a reliable screening test for exocrine pancreatic function. Border values or low values indicate a direct evaluation of exocrine pancreatic function. The simple test meal (water) method with determination of trypsin in duodenal juice gives, from a practical point of view, good information of the exocrine pancreatic function.The following plan of investigation is proposed: Step 1. careful clinical history and examination; Step 2. analysis of faeces for Giardia lamblia, entero‐pathogenic microorganisms, and chymotrypsin, sweat test; Step 3. peroral small intestinal biopsy and/or duodenal juice analysis, and finally—if steps 2 and 3 give normal results; Step 4. re‐evaluation of dietary history and tests to detect any food intolerance (e.g. carbohydrate).