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    The diagnosis of malabsorption syndrome and identification of the underlying cause can require extensive diagnostic testing. The first phase involves a thorough medical history and physical examination by a physician, who will then determine the appropriate laboratory studies and x rays to assist in diagnosis. A 72-hour stool collection may be ordered for fecal fat measurement; increased fecal fat in the stool collected indicates malabsorption. A biopsy of the small intestine may be done to assist in differentiating between malabsorption syndrome and small bowel disease. Ultrasound, computed tomography scan (CT scan), magnetic resonance imaging (MRI), barium enema, or other x rays to identify abnormalities of the gastrointestinal tract and pancreas may also be ordered.

    A newer method of obtaining diagnostic information about the small intestine was approved by the Food and Drug Administration (FDA) in 2001. Known as the M2A Imaging System, the device was developed by a company in Atlanta, Georgia. The M2A system consists of an imaging capsule, a portable belt-pack image receiver and recorder, and a specially modified computer. The patient swallows the capsule, which is the size of a large pill. A miniature lens in the capsule transmits images through an antenna/transmitter to the belt-pack receiver, which the patient wears under ordinary clothing as he or she goes about daily activities. The belt-pack recording device is returned after seven or eight hours to the doctor, who then examines the images recorded as a digital video. The capsule itself is simply allowed to pass through the digestive tract.

    Preparation requires only fasting the night before the M2A examination and taking nothing but clear liquids for two hours after swallowing the capsule. After four hours the patient can eat food without interfering with the test. As of the early 2000s, the M2A system is used to evaluate gastrointestinal bleeding from unknown causes, inflammatory bowel disease, some malabsorption syndromes, and to monitor surgical patients following small-bowel transplantation.

    Laboratory studies of the blood may include:

    • Serum cholesterol. May be low due to decreased fat absorption and digestion.
    • Serum sodium, potassium, and chloride. May be low due to electrolyte losses with diarrhea.
    • Serum calcium. May be low due to vitamin D and amino acid malabsorption.
    • Serum protein and albumin. May be low due to protein losses.
    • Serum vitamin A and carotene. May be low due to bile salt deficiency and impaired fat absorption.
    • D-xylose test. Decreased excretion may indicate malabsorption.
    • Schilling test. May indicate malabsorption of vitamin B12.

    Source: The Gale Group. Gale Encyclopedia of Medicine, 3rd ed.";

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