enteropathies

Enteropathies are disorders of the small intestine that impair digestion and absorption. They can be congenital or acquired and may involve mucosal, submucosal, or deeper structures. Clinically they often present with chronic diarrhea, steatorrhea, weight loss, and abdominal discomfort.

Classification is broad. Primary enteropathies arise from intrinsic intestinal disease; secondary enteropathies result from systemic illnesses, infections, medications, or nutritional deficiencies. Major categories include infectious enteropathies, inflammatory or autoimmune enteropathies (such as celiac disease), nutritional and pancreatic-biliary disorders, congenital enteropathies, and medication-induced forms.

Pathophysiology typically involves mucosal injury with villous atrophy or blunting, crypt hyperplasia, and loss of absorptive surface. This leads to impaired absorption of fats, carbohydrates, vitamins, and minerals and may increase intestinal permeability.

Common etiologies include autoimmune enteropathies such as celiac disease; Crohn disease involving the small bowel; infectious enteropathies; pancreatic insufficiency and bile acid malabsorption; tropical or post-infectious enteropathy; and congenital disorders like microvillus inclusion disease.

Diagnosis relies on history, examination, and targeted tests. Stool studies, including fecal fat, help assess steatorrhea. Serology for celiac disease (tTG IgA) with total IgA, and small-bowel biopsy by endoscopy are informative. Imaging such as MR enterography may be used for suspected involvement.

Management focuses on treating the underlying cause and providing nutritional support. Rehydration and electrolyte management are essential. Specific therapies include gluten-free diet for celiac disease, pancreatic enzyme replacement for insufficiency, antimicrobial therapy for infections, and immunosuppression for inflammatory enteropathies.

Prognosis varies by etiology. Some enteropathies are curable or controllable with diet or infection treatment, while others require long-term management and monitoring for malnutrition and micronutrient deficiencies.