A study of malabsorption in intestinal tuberculosis: stagnant loop syndrome

Abstract

A study was carried out in the patients with intestinal tuberculosis and obstruction requiring surgery to determine the pathogenesis of malabsorption in this condition. Fifteen of the 20 patients studied had malabsorption, nine of 17 (53%) had intestinal bacterial overgrowth and 10 of 16 (62.6%) had free bile acids in their jejunal aspirates. In a comparable group of nontuberculus intestinal obstruction requiring surgery, six of seven (85.7%) had malabsorption, and four of five (80%) had both the bacterial overgrowth as well as bile salt deconjugation. Among a group of 10 patients with intestinal tuberculosis without significant obstruction, four were found to have malabsorption but only one had evidence of bacterial overgrowth and bile salt deconjugation. In contrast, only one of the 10 patients with extraintestinal tuberculosis and none of the 12 healthy, normal subjects had malabsorption. None had bacterial overgrowth or bile salt deconjugation in either group. Resection of the obstructing lesion corrected the malabsorption as well as the bacterial overgrowth and the bile salt deconjugation in all four patients tested with intestinal tuberculosis. Malabsorption in intestinal tuberculosis thus appears to be associated with obstruction rather than with the tuberculous process. Demonstration of bacterial overgrowth and bile salt deconjugation in the upper small intestine of patients with intestinal tuberculosis with obstruction and malabsorption indicate the presence of a stagnant loop syndrome.

Surgical management of abdominal tuberculosis: a retrospective study from Central India

“…In the study of RK Tandon, biochemical evidence of malabsorption was reported in 75% of patients with intestinal obstruction and in 40% of those without it. 16 The cause of malabsorption in intestinal tuberculosis is postulated to be bacterial overgrowth in a stagnant loop, bile salt deconjugation, diminished absorptive surface due to ulceration, and involvement of lymphatic and lymph nodes. The duration of sickness in the study population before hospital admission ranged from 4 days to 2 years, with mean of 4 months.…”

Tropical malabsorption

“…Biochemical evidence of malabsorption can be found in many patients with intestinal tuberculosis, even though the patient may not present with a clinical diagnosis of the malabsorption syndrome. In one study, biochemical evidence of malabsorption was found in 75% of patients with intestinal tuberculosis with intestinal obstruction, but in only 40% of patients 45 The causes of malabsorption include bacterial overgrowth in a stagnant loop, bile salt deconjugation and diminished absorptive surface due to ulceration and lymphatic obstruction. 46 Considerable abdominal pain in a patient with malabsorption syndrome should alert the clinician to the diagnosis.…”

Faecal calprotectin levels differentiate intestinal from pulmonary tuberculosis: An observational study from Southern India

“…malabsorption of nutrients and/or decreased intestinal transit time. 29 Third, CRP levels may be elevated in both pulmonary and extra-pulmonary active TB. 30,31 A small study on TB-diseased children found an inverse relationship between CRP and body mass index and between leptin levels and CRP, with poorer prognosis in patients with the highest CRP levels.…”