Malabsorption panel: Filling a gap in pediatric care

Eye on Innovation

In a world of ever-faster technical change, Mayo Clinic Laboratories is uniquely positioned to innovate. Collaboration with clinicians pinpoints unmet patient needs and facilitates the development of diagnostic

testing that provides answers.

Chronic diarrhea and unexplained weight loss in children provoke anxiety, for youngsters and their parents. The daily discomfort is distressing, and weight loss triggers concerns about children's growth and development.

These symptoms can indicate that a child's digestive system isn't properly absorbing nutrients from food. Pinpointing the cause of this malabsorption is key to timely and appropriate treatment. Laboratory testing can provide answers. But the existing stool tests are cumbersome for physicians and patients.

Mayo Clinic Laboratories is committed to innovation that provides the right test at the right time for the right patients. That effort always starts with identifying gaps in patient care. Filling those gaps sometimes involves not developing new tests but finding ways to make existing tests more efficient and easier for patients.

The laboratories' novel pediatric Malabsorption Evaluation Panel (Mayo ID: MALP), which bundles four existing stool tests, is a prime example. The tests themselves aren't new. But the panel requires just one stool sample and yields swifter results, for streamlined diagnosis and greater patient comfort.

"This is the only existing panel that allows all four malabsorption tests to be run at the same time with a single specimen," says Puanani Hopson, D.O., a pediatric gastroenterologist at Mayo Clinic. "Performing four tests in one fell swoop can really narrow down your diagnostic differential and limit patient anxiety about testing. You can then move to the next step of treatment."

Puanani Hopson, D.O.

An efficient umbrella

Stool testing is a key component to diagnosing malabsorption. Mayo Clinic Laboratories' existing tests — pancreatic elastase, calprotectin, reducing substance, and alpha-1-antitrypsin — are highly accurate and cover a wide range of possible causes. Each of these tests remains available as a standalone.

"But when it comes to pediatric practice, we really need to move quickly to identify the cause of malabsorption. That's why we chose to create a bundle for these four tests," Dr. Hopson says. "The malabsorption panel is an efficient umbrella that allows physicians to hit big categories of the differential diagnosis pretty swiftly."

Particularly helpful for pediatric patients, the panel also eases the burden on families. "This is a group of patients that may have phobias or anxiety with testing," Dr. Hopson says. "Stool testing, in particular, can be quite cumbersome. Limiting patient anxiety was another important factor that led us to develop this bundled panel."

The unique malabsorption panel required an investment in time and effort — as well as collaboration between highly specialized research staff and physicians. As a clinician-researcher in the Mayo Clinic Children's Center, Dr. Hopson focuses on caring for children with digestive disorders. She is very familiar with the patient care gaps surrounding malabsorption testing.

"In the past, I was oftentimes called by the lab because I had ordered four stool tests and the patient was able to submit only a small specimen," she says. "Then I had to choose which test was the highest priority, and also call the family and ask them to submit another stool sample. That's an additional stressor for the family waiting on a diagnosis and a stressor for the patient having to submit a stool sample, which is never fun."

Dr. Hopson likens the development of the malabsorption panel to previous efforts to streamline testing for infectious causes of diarrhea.

"It used to be that when a patient came into the emergency room with acute diarrhea, you'd have to do separate antigen tests for a specific Giardia pathogen or C. difficile. It was pretty cumbersome," Dr. Hopson says.

Eventually, a single polymerase chain reaction panel was developed to test for multiple pathogens. "Now, we all use this panel to test pathogens together rather than separately," Dr. Hopson says. "We’re always progressing in the medical field."

"That's the theory behind what Mayo Clinic Laboratories is doing with this pediatric malabsorption panel," Dr. Hopson says. "We think it will change the game in looking for malabsorption issues and be helpful for patients and clinicians going forward."

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Barbara J. Toman

Barbara J. Toman is a Senior Communications Specialist at Mayo Clinic Laboratories. She is also the science writer for Mayo’s Neurosciences Update newsletter, which helps referring physicians to stay informed about Mayo’s treatment and research. Barbara has worked at Mayo Clinic since 2007. She enjoys international travel and cooking.