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Practical advice in the diagnosis of malabsorption

Practical advice in the diagnosis of malabsorption
1. Stools may appear normal even when laden with excess fat.
2. Patients with carbohydrate malabsorption may have watery diarrhea and complain of excess flatus and abdominal distension. Symptoms typically occur within 90 minutes of carbohydrate ingestion.
3. Abdominal pain is unusual in malabsorption except in the case of selected diseases (eg, chronic pancreatitis, Crohn disease, or intestinal pseudo-obstruction).
4. Patients with celiac disease often have a childhood history of ill health and a positive family history of gluten sensitivity or Crohn disease. A subtle presentation, such as anemia or mildly elevated liver enzymes, is commonly the sole initial indication of disease.
5. The prevalence of celiac disease in patients with type 1 diabetes mellitus is higher than the general population.
6. Always ask about previous abdominal surgery.
7. Always ask about a history of recurrent peptic ulcer disease.
8. Do not forget to ask about alcohol consumption. It usually takes 10 to 20 years for pancreatic insufficiency to develop in alcoholics.
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