Malabsorption and Small-Intestine Diseases

  • Martin H. Floch
Part of the Topics in Gastroenterology book series (TGEN)


The small intestine is the most important organ relating to nutrition. Humans need at least the duodenum and part of the proximal jejunum to survive by eating. With the advent of intravenous hyperalimentation, life can be maintained by intravenous feedings. However, to lead a normal life, the small intestine must function adequately. Until 1956 the small intestine had occupied a minor, but interesting, role in medicine. In that year, Drs. Margot Shiner1 and William H. Crosby and H. W. Kugler2 independently developed instruments to obtain peroral biopsy specimens from human small bowel, which made the study of intestinal mucosal pathology on fresh specimens possible. It led to the discovery of mucosal lesions in tropical and nontropical sprue, exudated enteropathy, and many other diseases. There occurred a reawakening of interest in the role of the small intestine in metabolism. The addition of the triple lumen tube to the peroral biopsy technique permitted careful correlation of histology and chemistry and opened new vistas for study that has resulted in a vast amount of information on man.


Celiac Disease Coeliac Disease Breath Test Lactose Intolerance Dermatitis Herpetiformis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Shiner M: Duodenal biopsy. Lancet 1:17, 1956.Google Scholar
  2. 2.
    Crosby WH, Kugler HW: Intraluminal biopsy of the small intestine: The intestinal biopsy capsule. Am JDig Dis 2: 236, 1957.CrossRefGoogle Scholar
  3. 3.
    Sheehy TW, Floch MH: The Small Intestine-Its Function and Diseases. New York: Hoeber Medical Division, Harper & Row Publishers Inc, 1964.Google Scholar
  4. 4.
    Astaldi G, Stroselli E: Biopsy of normal intestine. Am J Dig Dis 5:175, 1960.CrossRefGoogle Scholar
  5. 5.
    Ingelfinger EI: Gastrointestinal absorption. Nutr Today 2: 2, 1967.CrossRefGoogle Scholar
  6. 6.
    Shiner M: Electron microscopy of jejunal mucosa. Clin Gastroenterol 3: 33, 1974.Google Scholar
  7. 7.
    Haubrich WS, Watson JHL, O’Driscoll W, et al: Electron microscopy of the free border of human intestinal epithelial cell. Henry Ford Hosp Med Bull 7:113, 1959.Google Scholar
  8. 8.
    Trier JS: Morphology of the epithelium of the small intestine, in Code C (ed.): Handbook of Physiology. Alimentary Canal. Washington, DC: American Physiology Society, 1968, vol. 3.Google Scholar
  9. 9.
    Leblond CP, Stevens CE: Constant renewal of the intestinal epithelium in the albino rat. Anat Rec 100: 357, 1948.CrossRefGoogle Scholar
  10. 10.
    Williamson RCN: Intestinal adaptation structural, functional, cytokinetic changes. N Eng J Med 298: 1393, 1444, 1978.CrossRefGoogle Scholar
  11. 11.
    Parrot DMV: The gut as a lymphoid organ. Clin Gastroenterol 5: 211, 1976.Google Scholar
  12. 12.
    Brandzaeg P, Baklien K: Immunoglobulin-producing cells in the intestine in health and disease. Clin Gastroenterol 5: 251, 1976.Google Scholar
  13. 13.
    Davenport HW: Physiology of the Digestive Tract, ed 4. Chicago: Year Book Medical Publishers, chap 14.Google Scholar
  14. 14.
    Breberdorf F: Normal mechanisms of water and electrolyte absorption by the gastrointestinal tract, in Dietschy JM (ed): Disorders of the Gastrointestinal Tract. New York: Grune & Stratton, 1976, p 33.Google Scholar
  15. 15.
    Fordtran JS, Dietschy JM: Water and electrolyte movement in the intestine. Gastroenterology 50: 263, 1966.Google Scholar
  16. 16.
    Curan PF: Water absorption from the intestine. Am J Clin Nutr 21: 781, 1968.Google Scholar
  17. 17.
    Bergoz R: Trehalose malabsorption causing intolerance to mushrooms. Gastroenterology 60: 909, 1971.Google Scholar
  18. 18.
    Cooke WT, Asquith P: Coeliac disease. Clin Gastroenterol 3: 1, 1974.Google Scholar
  19. 19.
    Stokes PL, Asqeroluith P, Cooke WT: Genetics of coeliac disease. Clin Gastroenterol 2: 547, 1973.Google Scholar
  20. 20.
    Brow JR, Parker F, Weinstein WM, et al: The small intestinal mucosa in dermatitis hepetiformis. Severity and distribution of the small intestinal lesion and associated malabsorption. Gastroenterology 60: 355, 1971.Google Scholar
  21. 21.
    Marks J, Shuster S: Intestinal malabsorption and the skin. Gut 12: 938, 1971.CrossRefGoogle Scholar
  22. 22.
    Moorthy AV, Zimmerman SW, Maxim PE: Dermatitic hepetiformis and coeliac disease. Association with glomerulonephritis, hypocomplementia, and circulating immune complexes. JAMA 239: 2019, 1978.CrossRefGoogle Scholar
  23. 23.
    Gray GM: Maldigestion and malabsorption: Clinical manifestations and specific diagnosis, in Sleisinger M, Fordtran J (ed): Gastrointestinal Diseases, ed 2. Philadelphia: WB Saunders Co, 1978, p 272.Google Scholar
  24. 24.
    Hines JD, Hoffbrand AV, Molleir DL: The hematologic complications following partial gastrectomy. Clin J Med 43: 555, 1967.Google Scholar
  25. 25.
    Toskes PP, Deren JJ: Vitamin B12 absorption and malabsorption. Gastroenterology 65: 662, 1973.Google Scholar
  26. 26.
    Halsted CH, Robles EA, Mezey E: Intestinal malabsorption in folate-deficient alcoholics. Gastroenterology 64: 526, 1973.Google Scholar
  27. 27.
    Bayless TM, Rosenweig NS: A racial difference in incidence of lactose deficiency. A survey of milk intolerance and lactose deficiency in healthy adult males. JAMA 197: 968, 1966.CrossRefGoogle Scholar
  28. 28.
    Sahi T: The inheritance of selective adult-type lactose malabsorption. Scand J Gastroenterol 9 (suppl 30), 1974.Google Scholar
  29. 29.
    Welsch JD, Robrer V, Knudsen KB, et al: Isolated lactose deficiency. Correlation of laboratory studies and clinical data. Arch Intern Med 120: 261, 1967.CrossRefGoogle Scholar
  30. 30.
    Metz G, Jenkins DJA, Peters Ti, et al: Breath hydrogen as a diagnostic method for hypolactasia. Lancet 1: 1155, 1975.CrossRefGoogle Scholar
  31. 31.
    Maffei HVL, Metz GL, Jenkins DJA: Hydrogen breath test: Adaptation of a simple technique to infants and children. Lancet 1:1110, 1976.CrossRefGoogle Scholar
  32. 32.
    Metz G, Jenkins DJA, Newman A, et al: Breath hydrogen in hyposucrasia. Lancet 1: 1119, 1976.Google Scholar
  33. 33.
    Metz G, Drasar BS, Gassull MA, et al: Breath hydrogen test for small intestinal bacteria colonization. Lancet 1: 668, 1976.CrossRefGoogle Scholar
  34. 34.
    Marshak RH, Lindner AE: Radiology of the Small Intestine, ed 2. Philadelphia: WB Saunders Co, 1976.Google Scholar
  35. 35.
    Levitt MD, Donaldson RM: Use of respiratory hydrogen (H2) excretion to detect carbohydrate malabsorption. J Lab Clin Med 75: 937, 1970.Google Scholar
  36. 36.
    Calloway DH, Murphy EL, Bauer D: Determination of lactose intolerance by breath analysis. Am J Dig Dis 14: 811, 1969.CrossRefGoogle Scholar
  37. 37.
    Fromm H. Hofmann AF: Breath test for altered bile-acid metabolism. Lancet 2: 621, 1971.CrossRefGoogle Scholar
  38. 38.
    Sherr HP, Sasaki Y, Newman A, et al: Detection of bacterial deconjugation of bile salts by a convenient breath-analysis technique. N Eng J Med 285: 656, 1971.CrossRefGoogle Scholar
  39. 39.
    Fromm H, Thomas PJ, Hofmann AF: Sensitivity and specificity in tests of distal ilea! function: Prospective comparison of bile acid and vitamin B12 absorption in ileal resection patients. Gastroenterology 64: 1077, 1973.Google Scholar
  40. 40.
    Lauterberg BH, Newcomer AD, Hofmann AF: Clinical value of the bile acid breath test. Mayo Clin Proc 53: 227, 1978.Google Scholar
  41. 41.
    Newcomer AD, Hofmann AF, DiMagno EP, et al: Triolein breath test. A sensitive and specific test for fat malabsorption. Gastroenterology 76: 6, 1979.Google Scholar
  42. 42.
    Kamath MD, Murugasu R: A comparative study of four methods for detecting Giardia lamblia in children with diarrheal disease and malabsorption. Gastroenterology 66: 16, 1974.Google Scholar
  43. 43.
    Peterson H: Giardiasis (lambliasis). Scand J Gastroenterol7 (suppl 14), 1972.Google Scholar
  44. 44.
    Trier J: Diagnostic value of peroral biopsy of the proximal small intestine. N Engl J Med 285: 1470, 1971.CrossRefGoogle Scholar
  45. 45.
    Whitehead R: Mucosal Biopsy of the Gastrointestinal Tract. Philadelphia: WB Saunders Co, 1973.Google Scholar
  46. 46.
    Trier JS: Diagnostic usefulness of small intestinal biopsy. Viewpoints Dig Dis 9: 1, 1977.Google Scholar
  47. 47.
    Wilson FA, Dietschy JM: Differential diagnostic approach to clinical problems of malabsorption. Gastroenterology 61: 911, 1971.Google Scholar
  48. 48.
    Gee S: On the coeliac affection. St. Bartholomew’s Hosp Rep 24: 17, 1888.Google Scholar
  49. 49.
    Herter CA: On Infantalism from Chronic Intestinal Infection. New York: Macmillan, 1908, p 14.Google Scholar
  50. 50.
    Dicke WK: Celiac disease: A study of the damaging effect of some cereals, especially wheat, caused by a factor outside of their starch, on the fat absorption of children with celiac disease. Presented at the International Congress of Paediatrics, Zurich, 1950.Google Scholar
  51. 51.
    Dicke WK, Weijers HA, van de Kamer JH: Celiac disease: Presence in wheat of factor having deleterious effect in cases of celiac disease. Acta Paediatrica 42: 34, 1953.CrossRefGoogle Scholar
  52. 52.
    Weijers HA, van de Kamer JH, Dicke WK: Celiac disease. Adv Pediatr 9: 277, 1957.Google Scholar
  53. 53.
    van de Kamer JH, Weijers HA: Coeliac disease. V. Some experiments on the cause of the harmful effect of wheat gliadin. Acta Paediatrica 44: 465, 1955.CrossRefGoogle Scholar
  54. 54.
    Cooke WT, Peeney ALP, Hawkins CF: Symptoms, signs and diagnostic features of idiopathic steatorrhea. Q J Med 22: 59, 1953.Google Scholar
  55. 55.
    Anderson CM: Histological changes in the duodenal mucosa in coeliac disease: Reversibility during treatment with a wheat gluten free diet. Arch Dis Child 35: 419, 1960.CrossRefGoogle Scholar
  56. 56.
    Rubin CE, Brandborg LL, Phelps PC, Taylor HC: The apparent identification and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic spine. Gastroenterology 38: 28, 1960.Google Scholar
  57. 57.
    McNeish AS, Anderson CM: Celiac disease. The disorder in childhood. Clin Gastroenterol 3: 127, 1974.Google Scholar
  58. 58.
    Asquith P: Celiac disease immunology. Clin Gastroenterol 3: 213, 1974.Google Scholar
  59. 59.
    Patey AL: Gliadin: The protein mixture toxic to coeliac patients. Lancet 1: 722, 1974.CrossRefGoogle Scholar
  60. 60.
    Evans DJ, Patey AL: Chemistry of wheat proteins and the nature of the damaging substances. Clin Gastroenterol 3: 199, 1974.Google Scholar
  61. 61.
    Cornell Hi, Townley RRW: The toxicity of certain cereal proteins in coeliac disease. Gut 15: 862, 1974.CrossRefGoogle Scholar
  62. 62.
    Cornell HJ, Townley RRW: Investigation of possible intestinal peptidase deficiency in coeliac disease. Clin Chim Acta 43: 113, 1973.CrossRefGoogle Scholar
  63. 63.
    Dissanayake AS, Jerrome DW, Offord RE, et al: Identifying toxic fractions of wheat gluten and their effect on the jejuna) mucosa in coeliac disease. Gut 15: 931, 1974.CrossRefGoogle Scholar
  64. 64.
    Dissanayake AS, Truelove SC, Whitehead R: Lack of harmful effect of oats on small-intestinal mucosa in coeliac disease. Br Med J 4: 189, 1974.CrossRefGoogle Scholar
  65. 65.
    Shiner M, Ballard J: Antigen-antibody reactions in jejunal mucosa in childhood coeliac disease after gluten challenge. Lancet 1: 1202, 1972.CrossRefGoogle Scholar
  66. 66.
    Seah PP, Fry L, Rossiter MA, et al: Anti-reticulin antibodies in childhood coeliac disease. Lancet 2: 681, 1971.CrossRefGoogle Scholar
  67. 67.
    Mowbray JF, Holborow EJ, Hoffbrand AV, et al: Circulating immune complexes in dermatitis herpetiformis. Lancet 1: 400, 1973.CrossRefGoogle Scholar
  68. 68.
    Sikora K, Anand BS, Truelove SC, et al: Stimulation of lymphocytes from patients with coeliac disease by a subfraction of gluten. Lancet 2: 389, 1976.CrossRefGoogle Scholar
  69. 69.
    Keuning JJ, Pena AS, van Leeuwen A, et al: HLA-DW3 associated with coeliac disease. Lancet 1: 506, 1976.CrossRefGoogle Scholar
  70. 70.
    Scott BB, Swinburne ML, Rajah SM, et al: HL-A8 and the immune response to gluten. Lancet 2: 374, 1974.CrossRefGoogle Scholar
  71. 71.
    Mann DL, Katz SI, Nelson DL, et al: Specific B-cell antigens associated with gluten-sensitive enteropathy and dermatitis herpetiformis. Lancet 1: 110, 1976.CrossRefGoogle Scholar
  72. 72.
    Fry L, Seah PP, Riches DJ, et al: Clearance of skin lesions in dermatitis herpetiformis after gluten withdrawal. Lancet 1: 288, 1973.CrossRefGoogle Scholar
  73. 73.
    Barry RE, Baker P, Read AE: Celiac disease. The clinical presentation. Clin Gastroenterol 3: 55, 1974.Google Scholar
  74. 74.
    Hood J, Mason AMS: Diffuse pulmonary disease with transfer defect occurring with coeliac disease. Lancet 1: 445, 1970.CrossRefGoogle Scholar
  75. 75.
    Smith MJL, Benson MK, Strickland ID: Coeliac disease and diffuse interstitial lung disease. Lancet 1: 473, 1971.CrossRefGoogle Scholar
  76. 76.
    Whorwell PJ, Foster KJ, Alderson MR, et al: Death from ischemic heart-disease and malignancy in adult patients with coeliac disease. Lancet 2: 113, 1976.CrossRefGoogle Scholar
  77. 77.
    Mawhinney H, Tomkin GH: Gluten enteropathy associated with selective IgA deficiency. Lancet 2: 121, 1971.CrossRefGoogle Scholar
  78. 78.
    Beale AJ, Parish WE, Douglas AP, et al: Impaired IgA responses in coeliac disease. Lancet 1: 1198, 1971.CrossRefGoogle Scholar
  79. 79.
    McCrea WM, Eastwood M, Martin M, et al: Neglected celiac disease. Lancet 1: 187, 1975.CrossRefGoogle Scholar
  80. 80.
    Stokes PL, Holmes GKT: Malignancy. Clin Gastroenterol 3: 159, 1974.Google Scholar
  81. 81.
    Sheedy CB, Keifetz N: Cooking for the Celiac Child. New York: The Dial Press Inc, 1969.Google Scholar
  82. 82.
    Wood MN: Gourmet Food on a Wheat Free Diet. Springfield: Charles C Thomas Publishers, 1967.Google Scholar
  83. 83.
    Malis F, Lojda Z, Fric P, et al: Disaccharides in celiac disease and mucoviscidosis. Digestion 5: 40, 1972.CrossRefGoogle Scholar
  84. 83a.
    Regan PT, Dimagno EP: Exocrine pancreatic insufficiency in celiac sprue. Gastroenterology 78: 484, 1980.Google Scholar
  85. 84.
    Alpers DH, Seetharam B: Pathophysiology of diseases involving intestinal brush-border proteins. N Engl J Med 296: 1047, 1977.CrossRefGoogle Scholar
  86. 85.
    Gryboski J: Gastrointestinal Problems for Infants. Philadelphia: WB Saunders Co, 1975.Google Scholar
  87. 86.
    Antonowicz I, Lloyd-Still JD, Khaw KT, et al: Congenital sucrase-isomaltase deficiency. Pediatrics 49: 847, 1972.Google Scholar
  88. 87.
    Ament M, Perera D, Esther L: Sucrase isomaltase deficiency-A frequently misdiagnosed disease. J Pediatr 83: 721, 1973.CrossRefGoogle Scholar
  89. 88.
    Gray GM, Conklin KA, Townley RRW: Sucrase-isomaltase deficiency: Absence of an inactive enzyme variant. N Engl J Med 294: 750, 1976.CrossRefGoogle Scholar
  90. 89.
    Lindquist B, Meenwise GW: Chronic diarrhea caused by monosaccharide malabsorption. Acta Paediatr Scand 51: 674, 1962.CrossRefGoogle Scholar
  91. 90.
    Anderson CM, Kerry KR, Townley RR: An inborn defect of intestinal absorption of certain monosaccharides. Arch Dis Child 40: 1, 1965.CrossRefGoogle Scholar
  92. 91.
    Lindquist B, Meeuwisse GW: Diets in disaccharidase deficiency and defective monosaccharide absorption. J Am Diet Assoc 48: 307, 1966.Google Scholar
  93. 92.
    Meeuwisse GW, Lindquist B: Glucose-galactose malabsorption. Acta Paediatr Scand 59: 74, 1970.CrossRefGoogle Scholar
  94. 93.
    von Reuss A: Über alimentare Saccharosurie bei darmkranken Sauglingsalter. Wien Klin Wochenschr 23: 123, 1910.Google Scholar
  95. 94.
    Holzel A, Schwarz V, Sutcliff KW: Defective lactose absorption causing malnutrition in infancy. Lancet 1: 1126, 1959.CrossRefGoogle Scholar
  96. 95.
    Gilat T, Kuhn R, Gelman E, et al: Lactase deficiency in Jewish communities in Israel. Am J Dig Dis 15: 895, 1970.CrossRefGoogle Scholar
  97. 96.
    Huang SS, Bayless TM: Milk and lactose intolerance in healthy orientais. Science 160: 83, 1968.CrossRefGoogle Scholar
  98. 97.
    Sahi T: Dietary lactose and the aetiology of human small-intestinal hypolactosia. Gut 19: 1074, 1978.CrossRefGoogle Scholar
  99. 98.
    Bayless TM, Rosensweig NS: A racial difference in the incidence of lactase deficiency. JAMA 197: 968, 1966.CrossRefGoogle Scholar
  100. 99.
    Gray M: Congenital and adult intestinal lactose deficiency. N Engl J Med 294: 1057, 1976.CrossRefGoogle Scholar
  101. 100.
    Paige DM, Bayless TM, Mellits ED: Lactose malabsorption in preschool black children. Am J Clin Nutr 30: 1018, 1977.Google Scholar
  102. 101.
    Dahlquist A: Specificity of the human small intestinal disaccharidases and indicative for heredity disaccharide intolerance. J Clin Invest 41: 463, 1962.CrossRefGoogle Scholar
  103. 102.
    Simons FJ: New light on ethic differences in adult lactose intolerance. Am J Dig Dis 18: 595, 1973.CrossRefGoogle Scholar
  104. 103.
    Lebenthal E, Tsuboi K, Kretchmer N: Characterization of human intestinal lactose and hetero-/3-galctosidases of infants and adults. Gastroenterology 67: 1107, 1974.Google Scholar
  105. 104.
    Newcomer AD, McGill DB, Thomas PJ, et al: Progressive comparison of indirect methods for detecting lactose deficiency. N Engl J Med 293: 1232, 1975.CrossRefGoogle Scholar
  106. 105.
    Bond JH, Levitt MD: Fate of soluble carbohydrate in the colon of rats and man. J Clin Invest 57: 1158, 1976.CrossRefGoogle Scholar
  107. 106.
    Kerry KR, Anderson M. A ward test for sugar in feces. Lancet 1: 981, 1964.CrossRefGoogle Scholar
  108. 107.
    Lebenthal E, Antonowicz I, Shwachman H: Correlation of lactose activity, lactose tolerance and milk consumption in different age groups. Am J Clin Nutr 28: 595, 1975.Google Scholar
  109. 108.
    Bedine MS, Bayless TM: Intolerance of small amounts of lactose by individuals with low lactase levels. Gastroenterology 65: 735, 1973.Google Scholar
  110. 109.
    Gilat T: Lactase in man: A non-adaptable enzyme. Gastroenterology 62: 1125, 1972.Google Scholar
  111. 110.
    Rosensweig NS, Herman RH: Diet and disaccharidase. Am J Clin Nutr 22: 99, 1969.Google Scholar
  112. 111.
    Jones DV, Latham MC, Kosikowski FV, et al: Symptom response to lactose-reduced milk in lactose-intolerant adults. Am J Clin Nutr 29: 633, 1976.Google Scholar
  113. 112.
    Lee DE, Lillibridge CB: A method for qualitative identification of sugars and semiquantitative determination of lactose content suitable for a variety of foods. Am J Clin Nutr 29: 428, 1976.Google Scholar
  114. 113.
    Paywe-Bose D, Welsh JD, Gearhardt HL, et al: Milk and lactose-hydrolyzed milk. Am J Clin Nutr 30: 695, 1977.Google Scholar
  115. 114.
    Paige DM, Bayless TM, Huang S, et al: Lactose hydrolysed milk. Am J Clin Nutr 28: 818, 1975.Google Scholar
  116. 115.
    Barer AL, Rosenberg IH: Refractory sprue: Recovery after removal of nongluten dietary proteins. Ann Intern Med 89: 505, 1978.Google Scholar
  117. 116.
    Katz AJ, Grand RJ: All that flattens is not “sprue.” Gastroenterology 76: 376, 1979.Google Scholar
  118. 117.
    Bampoe V, Avigad S, Sapsford RJ, et al: Lactose degradation by human enteric bacteria. Lancet 2: 125, 1979.CrossRefGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1981

Authors and Affiliations

  • Martin H. Floch
    • 1
    • 2
  1. 1.Yale University School of MedicineUSA
  2. 2.Department of Medicine, Section of Gastroenterology and NutritionNorwalk HospitalUSA

Personalised recommendations