**Section 3**

**Pathophysiology and Treatment of Pancreatic and Intestinal Disorders** 

266 New Advances in the Basic and Clinical Gastroenterology

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Wright, R.; Tsaih, S.; Schwartz, J.; Wright, R. & Hu, H. (2003). Association Between Iron

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Deficiency and Blood Lead Level in a Longitudinal Analysis of Children Followed in an Urban Primary Care Clinic. *J Pediatr.* Vol.142, No.1, pp 9-14, ISSN

**13** 

*Tunisia* 

**Emerging Approaches for the** 

*Unité de Biofermentation, Institut Pasteur de Tunis* 

Saoussen Turki and Héla Kallel

**Treatment of Fat Malabsorption** 

**Due to Exocrine Pancreatic Insufficiency** 

The main purpose of the gastrointestinal tract is to digest and absorb nutrients (fat, carbohydrates, and proteins), micronutrients (vitamins and trace minerals), water, and electrolytes. Digestion involves both mechanical and enzymatic breakdown of food. Mechanical processes include chewing, gastric churning, and the to-and-fro mixing in the small intestine. Enzymatic hydrolysis is initiated by intraluminal processes requiring gastric, pancreatic, and biliary secretions. The final products of digestion are absorbed through the

Malabsorption is a state arising from abnormality in absorption of food nutrients across the gastrointestinal (GI) tract. Depending on the abnormality, impairment can be of single or multiple nutrients leading to malnutrition and a variety of anaemias. Symptoms of malabsorption are varied because the disorder affects so many systems. General symptoms may include loss of appetite (anorexia), weight loss, fatigue, shortness of breath, dehydration, low blood pressure, and swelling (edema). Nutritional disorders may cause anemia (lack of iron, folate and vitamin B12), bleeding tendency (lack of vitamin K), or bone disease (lack of vitamin D). Gastrointestinal symptoms include flatulence, stomach distention, borborygmi (rumbling in the bowels), discomfort, diarrhea, steatorrhea (excessive fat in stool) and frequent bowel movements (Bai, 1998). Intestinal malabsorption can be due to : mucosal damage (enteropathy), congenital or acquired reduction in absorptive surface, defects of specific hydrolysis, defects of ion transport, impaired enterohepatic circulation or pancreatic insufficiency (Walker-Smith & al.,2002). This chapter will particularly focus on fat malabsorption, the overriding problem caused by severe

Pancreatic insufficiency is a condition commonly associated with diseases such as pancreatitis or cystic fibrosis. Patients suffering from these pathologies show a shortage of the digestive enzymes necessary to break down food. Hence, a common feature of these diseases is a severe dietary malabsorption due to the poor hydrolysis of lipid in the lumen of small intestine. Digestive lipases are the key enzymes of fat digestion. The most common example of these enzymes is human pancreatic lipase. Nevertheless, the human lipases include the pre-duodenal lingual and gastric lipase, the extra-duodenal pancreatic, hepatic,

**1. Introduction** 

intestinal epithelial cells.

pancreatic insufficiency.
