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Steatorrhea is not a really a condition but a symptom in which fecal matter is frothy, foul-smelling and floats because of a high fat content. It is common in malabsorption syndromes.
Steatorrhea is excessive excretion of fecal fat.
Causes & Development
Both digestive and absorptive disorders can cause steatorrhea. Digestive disorders affect the production and release of the enzyme lipase from the pancreas, or bile from the liver, which are substances that aid digestion of fats; absorptive disorders disturb the absorptive and enzyme functions of the intestine. Any condition that causes malabsorption or maldigestion is also associated with increased fecal fat. As an example, children with cystic fibrosis have mucus plugs that block the pancreatic ducts. The absence or significant decrease of the pancreatic enzymes, amylase, lipase, trypsin, and chymotrypsin limits fat, protein and carbohydrate digestion, resulting in steatorrhea due to fat malabsorption.
The underlying condition causes of steatorrhea include:Increased fecal fat levels are found in cystic fibrosis, malabsorption secondary to other conditions like Whipple's disease or Crohn's disease, maldigestion secondary to pancreatic or bile duct obstruction, and "short-gut" syndrome secondary to surgical resection, bypass, or congenital anomaly.
Signs & Symptoms
Steatorrhea is suspected when the patient has large, "greasy", and foul-smelling stools. Signs of steatorrhea include:- Foul-smelling feces
- Bulky stool
- Pale stools
- Loose stools
- Greasy stools
Diagnosis & Tests
Pancreatic and small intestinal diseases are the major causes of steatorrhea. If steatorrhea is due to chronic pancreatitis the bentiromide test is usually abnormal. In order to confirm the presence of pancreatic disease, a structural abnormality in the pancreas is sought by abdominal X-ray (calcification), ultrasound, CT scan, or ERCP.
When small intestinal disease is suspected as the source of steatorrhea, function tests of intestinal absorption may be performed. D-xylose absorption will test proximal small bowel function. The Schilling tests (I and II) and bile acid breath tests assess distal small bowel function. The Schilling test with antibiotics (part III) and the bile acid breath test will facilitate a diagnosis of bacterial overgrowth. Structural abnormalities of the small bowel are detected by barium studies and/or biopsy. Less common causes of steatorrhea require further diagnostic testing (e.g.duodenal aspiration for Giardia, serum gastrin for Zollinger-Ellison disease, etc.).
Treatment & Prevention
The dietary therapy of steatorrhea requires knowledge of the cause of the disease associated with the steatorrhea. Once the cause is established, then an approach to the dietary management can be adopted. Recommendations for either the treatment of the primary disease, limitation of fat intake, nutritional support, or pancreatic-enzyme replacement are made depending on the disease process.
In cases of chronic pancreatitis, a marked reduction in the secretion of pancreatic enzymes leads to steatorrhea. The first requirement in the treatment of steatorrhea is the ingestion of potent enzymes. A total of 30,000 units of lipase should be consumed with each meal. A few mouthfuls of the meal should be consumed priorto ingesting any enzymes in orderto protect enzymes against the harmful effects of gastric acid.
Therapy with potent pancreatic enzymes usually reduces the passage of bulky stools and permits significant weight gain. If this therapy is ineffective, however, the next important step in treatment of steatorrhea is the protection of enzymes against gastric acid. This protection can be achieved by either reducing the secretion of hydrogen ions with an H2 blocker (while continuing therapy with the same potent enzymes) or by ingesting pH-sensitive enteric-coated pancreatic enzymes. These enteric-coated preparations do not release enzymes until the milieu becomes alkaline (presumably within the duodenum).
The pH-sensitive enteric-coated enzymes may fail either because the pH within the stomach becomes alkaline prematurely (thereby permitting the premature release of enzymes which may then be exposed to a subsequent acid milieu) or because the size of the microspheres that contain the enzymes may be too large to be emptied in timely fashion from the stomach.
If pancreatic enzyme therapy with either an H2 blocker or enteric-coated preparation does not provide improvement, the next step is to decrease dietary fat to 50gm per day and to substitute medium-chain triglycerides (which do not require hydrolysis prior to absorption) for some dietary fat.
If steatorrhea persists, there may be excessive gastric secretion that requires a more potent H2 blocker. There appear to be factors other than acid that may prevent effectiveness of pancreatic enzymes. For example, even when sufficient pancreatic enzymes are instilled directly into the duodenum, steatorrhea may not be fully eliminated.
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Signs, symptoms & indicators of Steatorrhea:
Risk factors for Steatorrhea:
Recommendations and treatments for Steatorrhea: | | | | | Lab Tests/Rule-Outs |  Stool Exam | Both qualitative and quantitative tests are used to identify excessive fecal fat. The qualitative test involves staining a specimen of stool with a special dye, then examining it microscopically for evidence of malabsorption, such as undigested muscle fiber and various fats. The quantitative test involves drying and weighing a 72-hour stool specimen, then using an extraction technique to separate the fats, which are subsequently evaporated and weighed. This measurement of the total output of fecal fat per 24 hours in a three-day specimen is the most reliable test for steatorrhea.
This test requires a 72-hour stool collection. The patient should abstain from alcohol during this time and maintain a high-fat diet (100gm/day) for three days before the test, and during the collection period. The patient should call the laboratory for instructions on how to collect the specimen. |
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KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Proven definite or direct link | | | Highly recommended |
GLOSSARY
Abdomen (Abdominal)
That part of the body between the chest and the hips that contains the stomach, intestines, liver, bladder, pancreas and other organs.
Alkaline
A substance having a pH above that of neutral water (7.0) when in solution. Signified as pH (potential of Hydrogen), alkaline fluids, such as the blood (pH about 7.4), have the ability to neutralize acids (solutions below pH 7.0). Metabolic wastes are acids, and the alkaline reserve of the blood neutralizes them until they are excreted.
Amylase
A starch-digesting enzyme.
Aspiration
Inhalation, or removal of fluids or gases from a cavity using suction.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Bile
A bitter, yellow-green secretion of the liver. Bile is stored in the gallbladder and is released when fat enters the first part of the small intestine (duodenum) in order to aid digestion.
Biopsy
Removal of a sample of tissue from a living being for diagnosis. A pathologist later uses a microscope to look for certain features, such as cancer cells, in the sample. A fine-needle aspiration biopsy involves inserting a thin needle to remove a small amount of tissue, sometimes using CT or ultrasound to guide the needle. A core biopsy involves obtaining a sample of tissue with a thick needle or by inserting a thin, lighted tube (laparoscope) into a small incision in the abdomen. Another biopsy method is to remove tissue during an operation.
Carbohydrates (Carbohydrate)
The sugars and starches in food. Sugars are called simple carbohydrates and found in such foods as fruit and table sugar. Complex carbohydrates are composed of large numbers of sugar molecules joined together, and are found in grains, legumes, and vegetables like potatoes, squash, and corn.
Celiac Disease (Gluten Sensitivity)
A digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten. Common symptoms include diarrhea, increased appetite, bloating, weight loss, irritability and fatigue. Gluten is found in wheat (including spelt, triticale, and kamut), rye, barley and sometimes oats.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Chymotrypsin (Trypsin)
A digestive enzyme secreted by the pancreas into the small intestine which breaks down polypeptides or proteins.
Computerised Tomography (CAT Scan, Computed Tomography, Computerized Axial Tomography, CT Scan)
A scanning procedure using X-rays and a computer to detect abnormalities of the body's organs. This technique provides cross-sectional images of body organs, which is much clearer than those provided by conventional X-rays.
Crohn's Disease (Crohn's)
Chronic inflammatory disease of the gastrointestinal tract. The most common symptoms are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia.
Cystic Fibrosis
(CF) An incurable genetic disease involving a sticky buildup of mucus in the lungs (which makes breathing difficult and leads to infections), as well as pancreatic insufficiency (which leads to digestive problems). Symptoms include chronic cough producing thick mucus, excessive appetite combined with weight loss, intestinal disorders, salty sweat/skin and pneumonia. Lung-related problems are the most frequent cause of death. CF is a recessive disease, occurring only when a person inherits two mutated copies of the CF gene - one from each parent. Individuals with CF generally have a life expectancy of about 30 years.
Distal
Anatomically located further away from a point of reference, such as an origin or a point of attachment.
Duodenum (Duodenal)
First portion of the small intestine between the pylorus and jejunum, connecting to the stomach.
Enteric (Enteric-coated)
Pertaining to the small intestines. Enteric-coated: A coating that prevents a tablet or capsule from being digested until it reaches the small intestine.
Enzymes (Enzyme)
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Gastric
Of, relating to, or associated with the stomach.
Giardiasis (Giardia)
An intestinal tract infection caused by Giardia lamblia, a flagellate protozoa now common to much of the world. It is not normally a very serious infection, but nevertheless unpleasant.
Gram (gm, gms, Gramme, Grammes, Grams)
A metric unit of weight, there being approximately 28 grams in one ounce.
H2 Blockers (H2 Blocker)
Medications in this family sharply decrease stomach acid production. They are widely used for the treatment of ulcers as well as for mild cases of esophageal reflux (heartburn). Drugs that fall into this family include cimetidine (Tagamet, Tagamet HB); famotidine (Pepcid, Pepcid AC, Pepcid RPD); nizatidine (Axid, Axid AR); ranitidine hydrochloride (Zantac, Zantac EFFERdose, Zantac GELdose, Zantac 75).
Lipase
An enzyme secreted by the pancreas to assist in fat breakdown.
Lipid (Lipids)
Fat-soluble substances derived from animal or vegetable cells by nonpolar solvents (e.g. ether); the term can include the following types of materials: fatty acids, glycerides, phospholipids, alcohols and waxes.
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Malabsorption
Improper utilization of needed and available nutrients, either from impaired digestive function (such as B12 being unabsorbed because of gastritis), impaired absorption (poor Vitamin E absorption because of an inflamed ileum) or impaired transport (the diminished blood proteins of the advanced alcoholic). There are other causes as well.
Mucus (Mucous)
The viscous, slippery substance that consists chiefly of mucin, water, cells, and inorganic salts and is secreted as a protective lubricant coating by cells and glands of the mucous membranes.
Pancreas (Pancreatic)
Opposite the liver and behind the stomach, the pancreas has two main functions - to manufacture various enzymes for digestion, and to release hormones to help control the body's use of carbohydrates. It releases insulin to help each cell absorb glucose to burn as energy. In this way, insulin controls the amount of sugar (glucose) in the blood. Proper pancreatic function is very important: too much, too little, or no insulin production can be life-threatening. Some of the chemicals released by the pancreas are not hormones, but stimulate other glands to make hormones. Once again, balance is necessary. Nutritional requirements for the pancreas are many. Research indicates that chromium vitamins C, E, B-complex, calcium, magnesium and potassium are especially important.
Pancreatitis
Inflammation of the pancreas. Symptoms begin as those of acute pancreatitis: a gradual or sudden severe pain in the center part of the upper abdomen goes through to the back, perhaps becoming worse when eating and building to a persistent pain; nausea and vomiting; fever; jaundice (yellowing of the skin); shock; weight loss; symptoms of diabetes mellitus. Chronic pancreatitis occurs when the symptoms of acute pancreatitis continue to recur.
pH
A measure of an environment's acidity or alkalinity. The more acidic the solution, the lower the pH. For example, a pH of 1 is very acidic; a pH of 7 is neutral; a pH of 14 is very alkaline.
Protein (Proteins)
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Proximal
Nearer to a point of reference such as an origin, a point of attachment, or the midline of the body.
Serum
The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.
Small Intestine (Small Bowel)
The small intestine lies between the stomach and the large intestine. It is about 6 meters (20 feet) long and its primary function is to digest (break down) food and absorb nutrients (vitamins, minerals, proteins, carbohydrates, and fats). The small intestine makes up more than 70% of the length and 90% of the surface area of the gastrointestinal (GI) tract.
Steatorrhea
The presence of undigested fat in the feces. This may be the result of failing to inoculate fatty foods with enough surfactant (biliary soap) to digest them, the failure of the lower small intestine to absorb them, or simply too much fat for even normal digestion to handle. Sometimes this can indicate liver, gall bladder or lipid metabolism diseases. Usually the causes are subclinical and treatable with less invasive approaches such as herbs.
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach's mucous lining must constantly regenerate itself.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Triglyceride (Triglycerides)
The main form of fat found in foods and the human body. Containing three fatty acids and one unit of glycerol, triglycerides are stored in adipose cells in the body, which, when broken down, release fatty acids into the blood. Triglycerides are fat storage molecules and are the major lipid component of the diet.
Ultrasound
Ultrasound testing uses sound waves projected into the body to produce an image of internal organs, structures, tumors, etc. In this procedure, a gel is applied to the patient's skin, and a small device that emits ultrasonic pulses is slowly passed over the area. The sonic image produced is viewed on a monitor.
X-rays (X-ray)
High-energy radiation used to take pictures of areas inside the body.
Last updated: Jan 03, 2010
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