[www.ncbi.nlm.nih.gov]

Untreated steatorrhea leads to malnutrition and other complications such as fat-soluble vitamin deficiencies (A, D, E, and K). Identifying the cause of steatorrhea is vital for proper management and prevention of these complications.[31]

Patients with steatorrhea present with bulky, pale, foul-smelling oily stools. These fatty stools tend to float in the toilet bowl and often challenging to flush as well. In the early stages, steatorrhea may be asymptomatic and go unnoticed. Patients also have other nonspecific manifestations of fat malabsorption such as chronic diarrhea, abdominal discomfort, bloating sensation, and weight loss.

Most notable disorders in each category are given below[2][3][4][5][6][7][8][9][10][11]:

1. EPI due to chronic pancreatitis, cystic fibrosis (CF), and conditions resulting in pancreatic duct obstruction or resection of the pancreas (e.g., pancreatic tumors)

2. Bile acid deficiency either due to cholestasis e.g. primary biliary cirrhosis, currently referred to as primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), or inability to absorb bile acids in the distal ileum resulting in diminished bile acid pool e.g. ileal resection or Crohn disease of the ileum or deconjugation of bile acids e.g., small intestinal bacterial overgrowth (SIBO)

3. Diseases affecting proximal small intestines such as celiac disease, tropical sprue, giardiasis, Whipple disease, lymphoma, amyloidosis, SIBO, and HIV enteropathy

In the early stages, steatorrhea may be unrecognized by many patients due to minimal or nonspecific presenting symptoms.

Quantitative estimation of fecal fat (exceeding 7 g per 24 hours) is an essential first step for the diagnosis of steatorrhea. The standard method of fecal fat quantification is by calculating the coefficient of fat absorption (CFA).[24] With a standard quantity of fat ingestion, CFA is the percentage of dietary fat that is absorbed.[24] Patients should follow a strict diet for five days containing 100 g of fats daily.[24] Stools are collected in the last 72-hour for fecal fat estimation. CFA over 92% is considered normal.[24]

Different causes of steatorrhea lead to different complications. Following are some complications that can occur due to steatorrhea:

• Weight loss in adults and other consequences of malnutrition such as increased susceptibility to infections, and increased morbidity and mortality from various disease states. Additionally, in children, malnutrition results in growth failure and poor neurological development

• Deficiencies of fat-soluble vitamins (A, D, E, and K)

• Poor bone health resulting in osteopenia, osteoporosis, and fractures (CF, celiac disease)

• Iron deficiency anemia, zinc deficiency (celiac disease)

• Dermatitis herpetiformis, non-Hodgkin lymphoma, adenocarcinoma of the upper gastrointestinal tract (celiac disease)

• Megaloblastic anemia due to B12 deficiency (in terminal ileum disease and SIBO)

• Pancreatic pseudocyst, ascites, splenic vein thrombosis, diabetes, pancreatic cancer (chronic pancreatitis)

• Seizure, osteopenia, ataxia, early bruising, headache, hyposplenism, and tetany (celiac disease)

• Cirrhosis, end-stage liver disease (PBC, PSC), malignancies such as cholangiocarcinoma, colon cancer in PSC

It was advised earlier to decrease fat intake in patients with exocrine pancreatic insufficiency that helps in decreasing stool volume but it has been found that it causes malnutrition.



Edited 1 time(s). Last edit at 04/20/2022 09:14PM by Panchito.

Well I don't have steatorrhea because I can honestly say that my stools are not challenging to flush down the toilet.

There's an advertisement I'm sick of hearing for EPI 'meds'. So many health conditions and so many harmful drugs for all of them. It's sickening.