Vol. 14. Núm. 5.
Páginas 250-261 (Marzo 2024)

Actualización
Deficiencias enzimáticas intestinales y malabsorción. Intolerancias y alergias alimentarias. Otras causas de malabsorción intestinal. Síndromes linfoproliferativos y enfermedades sistémicas

Digestive enzyme deficiencies and malabsorption. Food intolerances and allergies. Other causes of intestinal malabsorption. Lymphoproliferative syndromes and systemic diseases

M. Pascual MatoabC. Rivas RivasabÁ. Antón RodríguezabJ. Crespo Garcíaab
Doi : https://10.1016/j.med.2024.03.004
Opciones
Resumen

Las intolerancias alimentarias son un grupo de reacciones adversas a alimentos no inmunomediadas que cursan con síntomas digestivos como diarrea y distensión abdominal, aunque también extradigestivos. En el caso de la intolerancia a la lactosa o la fructosa, el diagnóstico se realiza con pruebas complementarias como, por ejemplo, una prueba de aliento, mientras que en la intolerancia al gluten no celíaca el diagnóstico es clínico tras la exclusión de celiaquía o la alergia al trigo. El tratamiento de estas entidades pasa por la restricción dietética del componente que genera la intolerancia.

Existen síndromes malabsortivos desencadenados por enfermedades sistémicas como la amiloidosis, la enfermedad de Whipple o síndromes linfoproliferativos como el linfoma intestinal de células T, la EIPID o la afectación intestinal de enfermedad injerto contra huésped. Los síntomas digestivos suelen ser diarrea, anorexia, dolor abdominal y pérdida de peso. El tratamiento es el de la enfermedad subyacente, además de la reposición de los déficits nutricionales. La abetalipoproteinemia es una enfermedad genética en la que existe malabsorción de grasas y vitaminas liposolubles, cuyo tratamiento es su reposición nutricional.

Palabras clave
Intolerancias alimentarias
Malabsorción intestinal
Enfermedades sistémicas
Síndromes linfoproliferativos
Abstract

Food intolerances are a group of non-immune-mediated adverse reactions to food that progress with digestive symptoms such as diarrhea and abdominal distension as well as extra-digestive symptoms. In the case of lactose or fructose intolerance, a diagnosis is made with additional tests such as, for example, a breath test. In non-celiac gluten intolerance, the diagnosis is clinical after ruling out celiac disease or a wheat allergy. The treatment of these conditions involves dietary restriction of the component that generates the intolerance.

There are malabsorption syndromes triggered by systemic diseases such as amyloidosis, Whipple's disease, or lymphoproliferative syndromes such as intestinal T-cell lymphoma, immunoproliferative small bowel disease, or intestinal involvement of graft-versus-host disease. Digestive symptoms usually include diarrhea, anorexia, abdominal pain, and weight loss. Treatment is aimed at the underlying disease in addition to the correction of nutritional deficiencies. Abetalipoproteinemia is a genetic disease in which there is malabsorption of fats and fat-soluble vitamins. Its treatment involves nutrient replenishment.

Keywords
Food intolerances
Intestinal malabsorption
Systemic diseases
Lymphoproliferative syndromes

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