Malabsorption

Are you experiencing symptoms of malabsorption?

We provide malabsorption syndrome lab testing to locate the cause of your symptoms and get you back on track.

Malabsorption is a condition in which the small intestine doesn't adequately extract nutrients from food. Malabsorption causes people to feel bloated and have excessive gas passing through their intestines. It can also lead to other digestive problems, like inflammation or diarrhea.

Malabsorption is a disorder in which sufferers struggle to digest foods or absorb their nutrients. This condition occurs in many different diseases. It can cause sufferers to become generally malnourished or deficient in essential nutrients. Lab testing is used to evaluate individuals at a higher risk for malabsorption on account of a condition they suffer from, find the root causes, and determine the type and extent of nutritional deficiencies and possible complications, like anemia.

We offer lab testing for malabsorption syndrome and bile acid malabsorption to help identify the root cause of your problems so you can start feeling better right away. If you are suffering from malnutrition due to malabsorption, our lab tests will help identify your specific needs so that you can choose personalized treatment plans that meet your unique health goals! We offer affordable lab testing services that are fast and accurate so you can get back on track as soon as possible! Our friendly staff members are here 24/7 if you have any questions about our services or want more information about how we can help improve your quality of life today!

To get the right test for you, choose from the selections below.

For additional information on Malabsorption and Lab Testing, click here.


Name Matches
Serum albumin measurements are used in the monitoring and treatment of numerous diseases involving those related to nutrition and pathology particularly in the liver and kidney. Serum albumin is valuable when following response to therapy where improvement in the serum albumin level is the best sign of successful medical treatment. There may be a loss of albumin in the gastrointestinal tract, in the urine secondary to renal damage or direct loss of albumin through the skin. More than 50% of patients with gluten enteropathy have depressed albumin. The only cause of increased albumin is dehydration; there is no naturally occurring hyperalbuminemia

Serum alkaline phosphatase levels are of interest in the diagnosis of hepatobiliary disorders and bone disease associated with increased osteoblastic activity. Moderate elevations of alkaline phosphatase may be seen in several conditions that do not involve the liver or bone. Among these are Hodgkin's disease, congestive heart failure, ulcerative colitis, regional enteritis, and intra-abdominal bacterial infections. Elevations are also observed during the third trimester of pregnancy.


AST is widely distributed throughout the tissues with significant amounts being in the heart and liver. Lesser amounts are found in skeletal muscles, kidneys, pancreas, spleen, lungs, and brain. Injury to these tissues results in the release of the AST enzyme to general circulation. In myocardial infarction, serum AST may begin to rise within 6-8 hours after onset, peak within two days and return to normal by the fourth or fifth day post infarction. An increase in serum AST is also found with hepatitis, liver necrosis, cirrhosis, and liver metastasis.

An increase in serum bile acids concentration in the fasting state or postprandial is considered to be a specific indicator of liver disease. A decreased level indicates bile acid malabsorption, possibly due to ileal dysfunction.

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Measurement of the levels of bilirubin is used in the diagnosis and treatment of liver, hemolytic, hematologic, and metabolic disorders, including hepatitis and gall bladder obstruction. The assessment of direct bilirubin is helpful in the differentiation of hepatic disorders. The increase in total bilirubin associated with obstructive jaundice is primarily due to the direct (conjugated) fraction. Both direct and indirect bilirubin are increased in the serum with hepatitis.

Measurement of the levels of bilirubin is used in the diagnosis and treatment of liver, hemolytic, hematologic, and metabolic disorders, including hepatitis and gall bladder obstructive disease

Clinical Significance

Used to diagnose inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, or to differentiate IBD from irritable bowel syndrome (IBS).

 

Collection Instructions

Collect undiluted feces in clean, dry sterile leak-proof container. Do not add fixative or preservative.

 


 Specimens from children less than 4 years of age (i.e., less than 48 months) are not appropriate for this test. The test for children 4 years of age and younger is the Celiac Disease Comprehensive Panel, Infant (test code 15981).

Includes

Tissue Transglutaminase, IgA with Reflexes; Total IgA with Reflex

IMPORTANT - Note this is Reflex Test which if additional tests are run you will be charged for the specific tests that the lab peforms. Additional test will be run if the following criteria are met.


If the Tissue Transglutaminase IgA is positive,

1. Endomysial Antibody Screen (IgA) will be performed at an additional charge (CPT code(s): 86255).

If the Endomysial Antibody Screen (IgA) is positive, 

2. Endomysial Antibody Titer will be performed at an additional charge (CPT code(s): 86256).

If the Total IgA is less than the lower limit of the reference range, based on age

3. Tissue Transglutaminase IgG will be performed at an additional charge (CPT code(s): 83516).

Clinical Significance

Celiac disease is caused by an immune response to gluten in genetically sensitive individuals. The diagnosis is largely based on a biopsy of the small intestine, but serologic tests also help support a diagnosis and may assist identification of patients who may require biopsy.

Tissue transglutaminase antibodies (tTG, IgA) is a marker with 95% sensitivity and specificity. Total IgA is measured because 2-3% of celiac disease patients are IgA deficient. Because tTG, IgA, and anti-Gliadin IgA tend to decrease in patients on a gluten-free diet, these markers are also used to assess dietary compliance.

The endomysial antibody (EMA, IgA) assay has high specificity for celiac disease and is used to confirm positive anti-tTG results.


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Decreased levels of ceruloplasmin are found in Wilson''s Disease, fulminant liver failure, intestinal malabsorption, renal failure resulting in proteinuria, chronic active hepatitis and malnutrition. Elevated levels are found in primary biliary cirrhosis, pregnancy (first trimester), oral contraceptive use and in acute inflammatory conditions since ceruloplasmin is an acute phase reactant

A Complete Blood Count (CBC) Panel is used as a screening test for various disease states including anemia, leukemia, and inflammatory processes.

A CBC blood test includes the following biomarkers: WBC, RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, Platelet count, Neutrophils, Lymphs, Monocytes, Eos, Basos, Neutrophils (Absolute), Lymphs (Absolute), Monocytes(Absolute), Eos (Absolute), Basos (Absolute), Immature Granulocytes, Immature Grans (Abs)

NOTE: Only measurable biomarkers will be reported.

Reflex Parameters for Manual Slide Review
  Less than  Greater Than 
WBC  1.5 x 10^3  30.0 x 10^3 
Hemoglobin  7.0 g/dL  19.0 g/dL 
Hematocrit  None  75%
Platelet  100 x 10^3  800 x 10^3 
MCV  70 fL  115 fL 
MCH  22 pg  37 pg 
MCHC  29 g/dL  36.5 g/dL 
RBC  None  8.00 x 10^6 
RDW  None  21.5
Relative Neutrophil %  1% or ABNC <500  None 
Relative Lymphocyte %  1% 70%
Relative Monocyte %  None  25%
Eosinophil  None  35%
Basophil  None  3.50%
     
Platelet  <75 with no flags,
>100 and <130 with platelet clump flag present,
>1000 
Instrument Flags Variant lymphs, blasts,
immature neutrophils,  nRBC’s, abnormal platelets,
giant platelets, potential interference
     
The automated differential averages 6000+ cells. If none of the above parameters are met, the results are released without manual review.
CBC Reflex Pathway

Step 1 - The slide review is performed by qualified Laboratory staff and includes:

  • Confirmation of differential percentages
  • WBC and platelet estimates, when needed
  • Full review of RBC morphology
  • Comments for toxic changes, RBC inclusions, abnormal lymphs, and other
  • significant findings
  • If the differential percentages agree with the automated counts and no abnormal cells are seen, the automated differential is reported with appropriate comments

Step 2 - The slide review is performed by qualified Laboratory staff and includes: If any of the following are seen on the slide review, Laboratory staff will perform a manual differential:

  • Immature, abnormal, or toxic cells
  • nRBC’s
  • Disagreement with automated differential
  • Atypical/abnormal RBC morphology
  • Any RBC inclusions

Step 3 If any of the following are seen on the manual differential, a Pathologist will review the slide:

  • WBC<1,500 with abnormal cells noted
  • Blasts/immature cells, hairy cell lymphs, or megakaryocytes
  • New abnormal lymphocytes or monocytes
  • Variant or atypical lymphs >15%
  • Blood parasites
  • RBC morphology with 3+ spherocytes, RBC inclusions, suspect Hgb-C,
  • crystals, Pappenheimer bodies or bizarre morphology
  • nRBC’s

Comprehensive Metabolic Panel


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Copper is an essential element that is a cofactor of many enzymes. Copper metabolism is disturbed in Wilson's disease, Menkes disease, primary biliary cirrhosis, and Indian childhood cirrhosis. Copper concentrations increase in acute phase reactions and during the third trimester of pregnancy. Copper concentrations are decreased with nephrosis, malabsorption, and malnutrition. Copper concentrations are also useful to monitor patients, especially preterm newborns, on nutritional supplementation. Results of copper are often interpreted together with ceruloplasmin.

Clinical Significance

Copper is an essential element that is a cofactor of many enzymes. Copper metabolism is disturbed in Wilson's disease, Menkes disease, primary biliary cirrhosis, and Indian childhood cirrhosis. Copper concentrations increase in acute phase reactions. Copper concentrations are decreased with nephrosis, malabsorption, and malnutrition. Copper concentrations are also useful to monitor patients, especially preterm newborns, on nutritional supplementation. Results of copper are often interpreted together with ceruloplasmin.


This test will identify approximately 90% of Cystic Fibrosis (CF) mutations in the Caucasian population, and 97% in the Ashkenazi Jewish population. For prenatal specimens, use test code 10226.

Vitamin D (distinct from the vitamin D metabolites, 25-hydroxyvitamin D or 1, 25 dihydroxyvitamin D) is an essential nutrient obtained via exposure to sunlight (cholecalciferol) or diet (ergocalciferol). Measuring the vitamin D cholecalciferol and ergocalciferol can be used in the diagnosis and management of disorders of fat absorption such as Crohn's Disease.

IMPORTANT - Requires a Prescription for 50,000 UNITS VITAMIN D2 to conduct this test that is not part of this test.


Fatty Acid Profile, Comprehensive


Fatty Acid Profile, Essential (C12-C22)


The fecal occult blood test is an immunochromatographic fecal occult blood test that qualitatively detects human hemoglobin from blood in fecal samples. This is a useful screening aid for detecting primarily lower gastrointestinal (G.I.) disorders that may be related to iron deficiency anemia, diverticulitis, ulcerative colitis, polyps, adenomas, colorectal cancers or other G.I. lesions that can bleed. It is recommended for use by health professionals as part of routine physical examinations and in screening for colorectal cancer or other sources of lower G.I. bleeding.

See individual tests

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Immunoglobulin A (IgA)

Test Highlight

 

   

Clinical Use

  • Diagnose IgA deficiencies

  • Determine etiology of recurrent infections

  • Diagnose infection

  • Diagnose inflammation

  • Diagnose IgA monoclonal gammopathy

Clinical Background

IgA is the first line of defense for the majority of infections at mucosal surfaces and consists of 2 subclasses. IgA1 is the dominant subclass, accounting for 80% to 90% of total serum IgA and greater than half of the IgA in secretions such as milk, saliva, and tears. IgA2, on the other hand, is more concentrated in secretions than in blood. IgA2 is more resistant to proteolytic cleavage and may be more functionally active than IgA1.

IgA deficiency is the most prevalent isotype deficiency, occurring in 1/400 to 1/700 individuals. Many patients with IgA deficiency are asymptomatic, while others may develop allergic disease, repeated sinopulmonary or gastroenterologic infections, and/or autoimmune disease. Individuals with complete absence of IgA (<5 mg/dL) may develop autoantibodies to IgA after blood or intravenous immunoglobulin infusions and may experience anaphylaxis on repeat exposure. 

Elevated serum IgA levels are associated with infection, inflammation, or IgA monoclonal gammopathy.

 

The Lactoferrin IBD-CHEKĀ® is a qualitative (QL) Enzyme Linked Immunosorbent Assay (ELISA) for measuring concentrations of fecal lactoferrin, a marker for leukocytes. A positive level is an indicator of intestinal inflammation. The test can be used as an in vitro diagnostic aid to distinguish patients with active inflammatory bowel disease (IBD) from those with non inflammatory irritable bowel syndrome (IBS).

This is an Enzyme-Linked Immunosorbent Assay (ELISA) for measuring concentrations of fecal lactoferrin, a marker for leukocytes. An elevated level is an indicator of intestinal inflammation. The test can be used as an in vitro diagnostic aid to distinguish patients with active inflammatory bowel disease (IBD) from those with noninflammatory irritable bowel syndrome (IBS).

The methylmalonic acid (MMA) test may be used to help diagnose an early or mild vitamin B12 deficiency. It may be ordered by itself or along with a homocysteine test as a follow-up to a vitamin B12 test result that is in the lower end of the normal range.


The Nonesterified Fatty Acids (Free Fatty Acids) assay is useful in evaluating lipolysis and fatty acid oxidation. Nonesterified Fatty Acids may be useful in evaluating patients with hypoglycemia and for nutritional assessment.



Malabsorption is a disorder in which sufferers struggle to digest foods or absorb their nutrients. This condition occurs in many different diseases. It can cause sufferers to become generally malnourished or deficient in essential nutrients.

For the body to function, it needs nutrients that allow it to maintain and repair itself. Nutrients are also used to produce energy and fight off infections. There are many essential vitamins and minerals that people derive from their diet.

When we eat food, it goes through three stages of digestion.

The fats, proteins, and complex sugars that we eat are broken down by the acids in our stomach, bile from our livers, and enzymes from our pancreas. When these nutrients are broken down, micronutrients are released.

The cells around our small intestines absorb most of the nutrients we eat.

From there, these nutrients travel throughout the body, where they used or stored for later.

If this process is halted in any way, malabsorption can occur. The seriousness of this issue and the symptoms that it causes can vary based on several factors. Is the disorder inhibiting the body’s ability to digest food? Which nutrients is the body struggling to digest?

Digestive Issues

Enzymes from the pancreas and bile are both required to correctly digest proteins, fats, and carbohydrates. If the liver or pancreas is diseased, it could inhibit the body’s ability to produce these substances. This can also occur in patients that suffer from cystic fibrosis. Enzymes from the pancreas may struggle to reach the body’s digestive tract.

Issues With Absorption

When the intestines cannot properly absorb nutrients, these nutrients are expelled from the body through bowel movements. This may occur when the tissue or cells of the intestine has been damaged in some way. This can also happen when the intestine has been shortened it some way, which could happen after surgery. This reduces the intestine surface area, which means there is less time for the body to absorb nutrients from food as it moves throughout the digestive tract.

For the body to absorb vitamin B12, it needs acid from the stomach as well as a substance called intrinsic factor, which is made by the stomach’s parietal cells. Acid from the stomach causes B12 to separate from proteins, which allows the intrinsic factor and the B12 to bind. If either stomach acids or intrinsic factor is not present, B12 cannot be absorbed by the intestines, which can cause a deficiency in vitamin B12. This may occur as people grow older. Several medications can cause less stomach acid to be produced. This issue may also occur after gastric bypass surgery if someone has a disorder that has caused damage to their parietal cells, or in patients that are suffering from general malabsorption.

Issues With Transport

After nutrients have been absorbed, they are transported through the body by cells. In some cases, transport problems may occur. This may happen in patients that are experiencing issues with their lymphatic system, which can be caused by lymphoma or abetalipoproteinemia, which is a rare hereditary disorder.

Malabsorption And Its Causes

Many disorders and diseases that can lead to malabsorption. These are just a few examples:

  • Cancers, such as stomach cancer, pancreatic cancer, or lymphoma
  • Conditions that cause the bile ducts to close, narrow, or disappear like biliary atresia, or block bile flow, like cholestasis, which leaves the body with insufficient bile for digestion
  • Celiac disease, a type of autoimmune disease that causes the lining of the intestines to be damaged
  • Intestinal damage, like the damage that can occur during radiation treatment
  • Cystic fibrosis, a hereditary disorder that can impact the pancreas and make it more difficult for enzymes from the pancreas to be transported through the body
  • A decrease in the production of intrinsic factor
  • Disorders that make it more difficult for the body to circulate throughout the body, like heart disease
  • Enzyme deficiencies, or intolerances to foods, like lactose intolerance
  • Hyperthyroidism
  • AIDS
  • Digestive tract infections, such as parasitic, bacterial, and viral infections
  • Inflammatory bowel diseases, such as ulcerative colitis or Crohn’s disease
  • Medications that inhibit the production of stomach acid, like phenytoin
  • Liver disease
  • Pancreatic disease or insufficiency, which can cause the amounts of enzymes the pancreas produces to be decreased
  • Certain types of surgeries, like gastric bypass or bowel resection s
  • Scleroderma
  • Zollinger-Ellison syndrome, a rare disorder that causes tumors to develop on the intestines or pancreas

Symptoms Of Malabsorption

The symptoms of a patient with malabsorption can vary based on the root cause of their condition. The type of nutrient someone is deficient in and the extent of the deficiency. The signs may be severe immediately, or they may gradually get worse in time. The body stores certain nutrients, like vitamin B12. Because of this, symptoms of deficiency will only become apparent after stores have been depleted. This is also true of pancreatic enzyme deficiency. Symptoms may not show until approximately 90% of the production capacity in the body has been halted.

A few of the symptoms that are most associated with general malabsorption are:

  • Chronic diarrhea
  • Steatorrhea, which causes bulky and oily stools with a strong odor
  • Children may be diagnosed with failure to thrive.
  • Cramps, gas, bloating, and general abdominal pain.

Many symptoms may be caused by nutritional deficiencies or by poor health. Some of these symptoms are:

  • Fatigue
  • Ascites, which causes a build-up of fluid in the abdomen
  • Rashes or dry and scaly skin
  • Glossitis, which is inflammation of the tongue
  • Unexplained weight loss or decrease in muscle mass
  • Nausea
  • Accumulation of fluid in the feet, legs, and hands
  • Mouth inflammation
  • Gum disease
  • Paleness
  • Tingling or a number feeling in the hands or feet.
  • Pain in the muscles or bones
  • Issues that can occur when someone suffers from chronic malabsorption, include:
  • Iron deficiency (anemia)
  • Confusion or difficulty concentrate
  • Failure to grow or develop in children
  • Osteoporosis
  • Malnutrition
  • Deficiencies in key vitamins, like vitamins D, k, and A

Testing For Malabsorption

Testing is primarily done to:

Evaluate patients that may be at a higher risk for malabsorption on account of a condition they suffer from, like cystic fibrosis

Diagnose malabsorption, find the root causes, and determine the type and extent of nutritional deficiencies

Diagnose possible complications, like anemia

Determine how effective malabsorption treatment has been

While there are many tests that a doctor might order if they suspect malabsorption, there isn’t any single test that can provide a diagnosis. In most cases, when a professional is ordering tests, they will look at additional factors as well, such as medical and family history, symptoms, and the results of a general examination. In many cases, testing will be done in stages so that other possible causes can be ruled out before a doctor provides a diagnosis. Examples of tests that may be run include:

Typically, the first set of tests will look at the condition of cells, organs, and the digestive system. From there, healthcare providers will search for a cause for primary symptoms, such as chronic diarrhea, which is one of the most common malabsorption symptoms.

After that, follow-up tests may be ordered to find or rule out any diseases that are linked with malabsorption. Tests can also find deficiencies and potential complications.

Lab Tests

Common initial tests are:

Complete blood count: Evaluates red blood cells and checks for anemia, which can be caused by B12, folate, or iron deficiency.

Comprehensive metabolic panel: Detects electrolyte imbalances, evaluates proteins, and function of various organs, like the liver.

Prealbumin: Checks for protein malabsorption and can provide information about general nutritional deficiency

Erythrocyte sedimentation rate: Detects bodily inflammation, which can be caused by conditions like inflammatory bowel disease

Fecal fat testing: To see if the body is properly digesting fat

Stool culture: Used to check for bacterial infection

Diff toxin and Clostridium difficile testing: Checks for bacterial overgrowth, which can cause chronic diarrhea

Ova and parasite examination: Checks for parasites, which can cause chronic diarrhea

White blood cells in stool: Can be found in patients suffering from certain inflammatory intestinal conditions

Gastrointestinal pathogen testing: Looks for bacteria, parasites, and viruses in the stool, which can cause both diarrhea and infections of the digestive tract

Thyroid-stimulating hormone: Identifies or eliminated thyroid disease

After the initial round of tests, healthcare practitioners will look at those results as well as the information from examinations and order additional tests. Examples of tests that may be ordered include:

Fecal occult blood test: Looks for digestive tract bleeding

Testing for deficiency in vitamins like AB12and D

Prothrombin time: Tests for deficiency in vitamin K

Celiac disease testing

Celiac disease testing, such as trypsinogen, CF gene mutation panels, and sweat tests

Tests that evaluate the pancreatic function, like stool trypsin, fecal elastase, and blood tests

Other tests that may be ordered are:

Hydrogen breath test: Can identify digestive system bacterial overgrowth and lactose intolerance

Methylmalonic Acid: Can detect vitamin B12 deficiency before signs are shown

Xylose absorption test: Carbohydrate digestive testing

Lactose tolerance test: This test, which can be used when testing for lactose intolerance, can also be used when diagnosis malabsorption