Where can maldigestion occur?

Maldigestion due to Pancreatic insufficiency

The pancreatic enzymes break down the carbohydrates, proteins and fats in the food chime as soon as it is in the small intestine. The production or release of these enzymes can be impaired for various reasons, such as after surgery, inflammation of the organ, or other pancreatic diseases.

Maldigestion due to impaired biliary function

Another important digestive function is performed by bile. It is produced in the liver and stored in the gallbladder. It helps to break down and absorb fats from food. If the production or release is disturbed, some of the fats are excreted undigested and the so-called fatty stool occurs. This can be caused, for example, by gallstones, hepatitis or other diseases of the organ.

Maldigestion in the intestine

In the small intestine, the food is further reduced in size by muscle contractions and decomposed with the help of further enzymes. Some diseases of the intestine may also lead as a consequence of the underlying inflammation to reduced enzymes, such as enteritis or Chron's disease.

Coeliac disease is also one of the diseases that can take a severe course if undetected. It mainly affects the intestine and is caused by a reaction to gluten, a group of proteins found in certain grains. It has both allergy and autoimmune characteristics. Gluten-containing foods cause inflammation of the mucous membrane of the small intestine, which can be accompanied by destruction of the intestinal epithelial cells. As a result, nutrients are less easily absorbed, which can lead to serious deficiency symptoms. The symptoms and the severity of the clinical picture can be very different. Possible signs are among others diarrhoea, flatulence, fatty stool, loss of appetite and weight, nausea, fatigue. However, the disease can often go undetected for a long time. A causal therapy is currently not possible, only a lifelong abstention of gluten-containing foods helps3.

Other serious diseases of the gastrointestinal tract can - but do not have to - be at the root of maldigestion. Therefore, please always consult a physician if the symptoms persist or recur for a longer period of time. They can find out with certainty where your complaints come from. Only when the diagnosis has been made, do therapeutic measures make sense.

Carbohydrate maldigestion

Carbohydrates, like lactose (milk sugar) and fructose (fruit sugar), are some of the nutrients that provide the most calories in our diet. But if those aren’t correctly digested in the small intestine, it’s not only our calorie intake that may suffer. The sugars reach our colon undigested, where they will be fermented by bacteria as they pass the large intestine. The produced gas has been linked to an increased occurrence of functional digestive symptoms, including bloating, flatulence or abdominal pain.

Lactose or fructose maldigestion can also occur as a symptom of other diseases, like the already mentioned pancreatic insufficiency, Crohn’s or celiac disease, as a consequence of surgical intervention or simply as a result of getting older. Even though some people are born with a lactase (the enzyme responsible for breaking down milk sugars) deficiency, quite often it’s the natural process of ageing that decreases its efficiency. This can be combated either by the consumption of lactase preparations or by diet modifications that reduce lactose intake.

The lack of enzymes that help digest fructose - sucrase and maltase - can also be responsible for the occurrence of maldigestion symptoms – but often it may not be due to a reduction in enzyme activity, but more likely due to an excessive fructose intake in the first place. Human intestines can process only a limited amount of these sugars before they start fermenting in the colon. Similarly to lactose maldigestion, there are supplements available to combat the symptoms.