Which Conditions Cause Malabsorption?
A large number of diseases and physiological conditions may cause poor absorption of vitamin E.
1. Fat malabsorption due to liver and pancreatic insufficiency. Because the bile and the pancreatic juices are critical for absorption of vitamin E, any condition that compromises the function of the liver and pancreas can cause malabsorption.
These include:
- Cholestasis, a condition in which excretion of the bile is stopped or reduced. Cholestasis may be caused by inherited genetic defects and diseases and injury of the liver. Liver diseases such as hepatitis, alcoholic hepatitis and damage or inflammation of the liver from the use of powerful medicines or chemotherapy can affect the production of bile.
- Cystic fibrosis, a genetic disease in which the secretion of the pancreatic juice is blocked by thick mucous. Liver function and secretion of the bile may also be affected.
- Steattorhea, the inability to absorb fat, causes serious vitamin E deficiency. Steattorhea is associated with other conditions causing malabsorption such as cystic fibrosis, pancreatitis and is synonymous with celiac crisis, celiac rickets, celiac sprue, Gee disease, Gee-Herter disease, gluten enteropathy, idiopathic steatorrhea, nontropical sprue and wheat-sensitive enteropathy.
2. Malabsorption due to inflammation and surgical removal of part of the gut, infection, disturbance of its flora and diarrhea.
These include:
- Inflammatory bowel disease (IBD) includes diseases that cause inflammation in the intestines such as Crohn's and ulcerative colitis.
- Short bowel syndrome is the result of half or more of the small intestine being removed primarily in order to treat Crohn's disease.
- HIV is associated with fungal and other infections of the small intestine, which cause poor absorption of the nutrients particularly the fat-soluble ones. Other infectious diseases of the gut may cause malabsorption.
- Irritable Bowel Syndrome (IBS; also known as spastic colon or mucous colitis) can cause diarrhea and malabsorption.
- Bariatric surgery to treat obesity is often associated with nutrient deficiency proportional to the length of absorptive area.
3. Defects in the transport of vitamin E in the body have a serious indirect effect on absorption. These, mostly genetic defects, include:
- Abetalipoproteinemia is a rare inherited disease which prevents the formation of normal chylomicrons and very-low density lipoproteins (VLDL) which are essential for the transport of vitamin E. Patients with abetaliproteinemia 'absorb' vitamin E but most of the vitamin E never goes past the gut wall because the patients cannot produce these special vehicles which carry vitamin E.
- Ataxia with vitamin E deficiency, or familial isolated vitamin E deficiency, is an extremely rare genetic disease with symptoms very similar to those of another very rare disease called Friedreich ataxia. This genetic disease prevents the transfer of absorbed vitamin E from the liver to the blood and the tissues.
4. Aging. Aging is known to contribute to significant vitamin E deficiencies which result from diminished digestion and absorption capabilities and increased needs. It is estimated that over 50% of elderly may have suboptimal vitamin E status. Such deficiencies may be aggravated by chronic disease conditions and medications, which affect liver and other functions.