Intestinal Malabsorption Syndrome in Children: Clinical and Coprological Characteristics of Digestion and Absorption Processes

Abstract

Relevance. Intestinal malabsorption syndrome (IMS) in infants and preschool children is a multifactorial pathological condition characterized by considerable variability of clinical manifestations and a high frequency of associated functional disorders of the gastrointestinal tract (GIT). These features substantially complicate early diagnosis and identification of the main pathogenetic mechanism of the disease, which requires a comprehensive approach to the study of this pathology.

                 Aim of the study. The aim of this study is a detailed characterization of the clinical and coprological features of digestion and absorption in children with intestinal malabsorption syndrome in different age groups and clinical forms. This will allow a more accurate determination of the pathogenetic mechanisms and the development of effective methods for the diagnosis and treatment of this condition.

              Materials and methods. The study was conducted as part of a single-center clinical and laboratory project involving 53 children aged 1 to 7 years with intestinal malabsorption syndrome. The sample included 16 children in the 1–3 year age group, 26 in the 3–5 year age group and 11 children in the 5–7 year age group. The control group consisted of 66 healthy children of the same age range.

              All study participants underwent detailed history taking, a comprehensive clinical examination and laboratory tests, including complete blood count and urinalysis. The coprological examination was performed to assess the presence of steatorrhea, amylorrhea and creatorrhea, as well as to quantify fecal carbohydrate content and the level of fecal pancreatic elastase-1. These methods make it possible to objectively assess the functional state of the digestive system and to identify characteristic signs of intestinal malabsorption syndrome.

              Results. The study established that chronic constipation was observed in 25 (47.2%) children with IMS, functional dyspepsia in 5 (9.4%) children, functional disorders of the biliary tract in 16 (30.2%) children, and irritable bowel syndrome in 7 (13.2%) children.

             A decrease in fecal pancreatic elastase-1 was detected in 16 (30.2%) children with IMS, of whom 11 (20.8%) had a partial decrease and 5 (9.4%) a marked decrease. Increased fecal carbohydrate content was recorded in 36 (67.9%) children, which indicates impaired carbohydrate metabolism.

              Signs of impaired digestion in the coprogram were found with high frequency: creatorrhea was detected in 46 (86.8%) children, amylorrhea in 44 (83.0%) and steatorrhea in 30 (56.6%). These data indicate impaired digestion and absorption of food components.

            Among the clinical manifestations of the syndrome, the most frequent were flatulence (33 children, 62.3%), abdominal pain (32 children, 60.4%) and decreased appetite (29 children, 54.7%). Anemia was found in 32 (60.4%) children, residual signs of rickets in 30 (56.6%) and helminthiasis in 11 (20.8%) children, which emphasizes the complex nature of the pathological changes in IMS.

            Conclusion. Intestinal malabsorption syndrome (IMS) in children aged 1 to 7 years manifests through clinical symptoms and a variety of coprological markers indicating disorders of digestive and absorptive processes. The high frequency of creatorrhea and amylorrhea, combined with the relatively low frequency of decreased fecal pancreatic elastase-1, indicates the multifactorial nature of these disorders, which go beyond isolated exocrine pancreatic insufficiency. These data confirm the need for a comprehensive clinical and coprological examination of children with IMS, taking into account their age profile and concomitant functional disorders of the gastrointestinal tract.

Keywords:

Children, intestinal malabsorption syndrome, malabsorption

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