Diarrhea and malabsorption syndromes: clinical overview

The indications of enteroscopy in malabsorption syndromes are relatively limited with regard to investigations in cases of occult bleeding in the digestive tract and in detecting benign or malignant lesions of the small intestine. Nevertheless, extensive proximal push enteroscopy with detailed examination of a large area of the jejunum contributes to the differential diagnosis of chronic diarrhea or malabsorption syndrome both in children or adults. A unit of gastroenterology adequately equipped for push enteroscopy can be considered effective if it fulfills the following items: A high score of correct enteroscopic diagnoses corresponding to an appropriate selection of patients Optimal use of the possibilities offered by enteroscopy, i.e., samples for a complementary immunohistochemical examination, fluid for bacterial counts Good patient compliance with regard to further enteroscopies A worthwhile cost/benefit ratio as a result of fulfilling the above conditions and avoiding multiple, expensive biological tests and functional examinations that are less sensitive or less specific than the endoscopic examination itself. As yet, the cost/benefit ratio is unknown, because of the relative rarity of indications and the lack of multicentric studies.