Incidence, Diagnosis and Management of Malabsorption Following Oesophagectomy: a Systematic Review

J Gastrointest Surg. 2022 Aug;26(8):1781-1790. doi: 10.1007/s11605-022-05323-y. Epub 2022 Apr 28.


Background: Survival following oesophagectomy for cancer is improving, resulting in increased focus on quality of life and survivorship. Malabsorption syndrome is multifactorial and includes exocrine pancreatic insufficiency (EPI), small intestinal bacterial overgrowth (SIBO) and bile acid malabsorption (BAM). The aim of this study was to evaluate the reported incidence and management of malabsorption syndromes post-oesophagectomy.

Methods: A systematic search of PubMed, EMBASE, MEDLINE, Scopus and the Cochrane Library evaluating incidence, diagnosis and management of malabsorption was performed for studies published until December 2021.

Results: Of 464 identified studies, eight studies (n = 7 non-randomised longitudinal studies) were included where patients were identified with malnutrition following oesophagectomy. Studies included a combined sample of 328 (range 7-63) patients. Malabsorption syndromes including EPI, SIBO and BAM occurred in 15.9-100%, 37.8-100% and 3.33-100% over 21 days-60 months, 1-24 months and 1-24 months respectively. There was no consensus definition for EPI, SIBO or BAM, and there was variation in diagnostic methods. Diagnostic criteria varied from clinical (gastrointestinal symptoms or weight loss), or biochemical (faecal elastase, hydrogen breath test and Selenium-75-labelled synthetic bile acid measurements). Treatment modalities using pancreatic enzyme replacement, rifaximin or colesevelam showed improvement in symptoms and weight in all studies, where investigated.

Conclusions: Malabsorption syndromes following oesophagectomy are under-recognised, and thus under-reported. The resultant gastrointestinal symptoms may have a negative effect on post-operative quality of life. Current literature suggests benefit with outlined therapies; however, greater understanding of these conditions, their diagnosis and management is required to further understand which patients will benefit from treatment.

Keywords: Bile acid malabsorption; Exocrine pancreatic insufficiency; Malabsorption; Oesophagectomy; Small intestinal bacterial overgrowth.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Bile Acids and Salts / therapeutic use
  • Esophagectomy / adverse effects
  • Exocrine Pancreatic Insufficiency* / diagnosis
  • Exocrine Pancreatic Insufficiency* / epidemiology
  • Exocrine Pancreatic Insufficiency* / etiology
  • Humans
  • Incidence
  • Malabsorption Syndromes* / diagnosis
  • Malabsorption Syndromes* / etiology
  • Malabsorption Syndromes* / therapy
  • Quality of Life


  • Bile Acids and Salts