Steatorrhea

Steatorrhea can be defined as the present of excessive quantities of fat in the stool.

Clinical Presentation

The floating of the stool is also possible, due to the fact that excessive quantities of gas are present as well. The excess fat will cause the stool to have an oily aspect, such changes being accompanied by a characteristic foul odor. When one suffers from steatorrhea, fecal incontinence might be present. Some patients described oily anal leakage to be among the other symptoms they have experienced. When the main problem is caused by the lack of bile acids, the stool will turn a gray or pale color.

In patients who suffer from steatorrhea, abdominal pain and cramps are frequent. Patients complain of constant bloating, suffering either from constipation or diarrhea. In some cases, it is possible that blood is eliminated at the same time with the stool. Flatulence, nausea and vomiting complete the steatorrhea medical picture.

Apart from these symptoms, it is possible that the patients suffer from decreased density at the level of the bones. If there is a low light level, they may have problems with their vision (impaired vision). The more fat is eliminated through the stool, the more the patient will experience problems, especially when it comes to the blood clotting time (this will be reduced).

Steatorrhea Pictures

Picture of Steatorrhea – floating of fat in the stool

Steatorrhea Causes

These are the main causes that can lead to the appearance of steatorrhea:

• Inadequate production of bile (bile acids lacking)
  • Liver damage
  • Medication to reduce the level of lipids in the blood (hypolipidemic)
  • Surgical removal of gallbladder (cholecystectomy)
• Pancreatic enzyme defect
• Defect at the level of the mucosal cells
• Medication that has as purpose the blockage of fat absorption
• Fat rich diet (indigestible or excess oils in the diet might cause similar problems)
• Acromegaly treatment
  • Somatostatin analogues – octreotide, lanreotide (adverse effect)
• Other causes
  • Eating nuts in large quantities (such as cashews)
  • Jojoba oil (indigestible oil)
  • Escolar/oilfish consumption
  • Consumption of artificial fats.

Apart from the above-mentioned causes, it is worth mentioning that steatorrhea can be found in association with a number of medical conditions. For example, patients who suffer from different types of malabsorption also present steatorrhea. Among these conditions there are the celiac disease, the inflammatory bowel disease and the Bassen-Kornzweig syndrome (normal absorption of fat is prevented).

Patients who suffer from pancreatic conditions, such as exocrine pancreatic insufficiency or the inflammation of the pancreas (pancreatitis), can present steatorrhea. When the bile duct is obstructed by gallstones of different sizes, steatorrhea is going to occur as one of the consequences of this blockage. Excess fat in the stool is encountered in patients diagnosed with pancreatic cancer, if the biliary outflow is obstructed by the neoplastic growth. Patients who suffer from primary sclerosing cholangitis, a condition that affects the functioning of the bile ducts, present such problems as well.

Steatorrhea is encountered in patients who have been diagnosed with bacterial infections but also in those who suffer from the short bowel syndrome or cystic fibrosis. Excess quantities of fat in the stool are encountered in patients diagnosed with Zollinger-Ellison syndrome, parasitic infections (especially with giardia) and thyroid disorders (such as hyperthyroidism). Steatorrhea is often encountered in patients who abuse weight loss pills and in those who have been diagnosed with tropical sprue, a form of malabsorption which is characteristic only for certain tropical regions.

Diagnosis of Steatorrhea

These are the most common methods for diagnosis the underlying condition:

• Medical history of the patient
  • When did steatorrhea appear for the first time
  • Apart from the oily appearance, are there blood, excess mucus or pus present in the stool
  • Stool color change (when)
  • Other symptoms presented
  • Diet (current and if there were any recent changes)
  • Current and past treatments (including surgical interventions)
  • Similar problems in the past
  • Family medical history (inherited conditions)
• Physical examination
  • Palpation of abdomen
• Lab testing
  • Hepatic enzymes
  • Leukocytes
  • Complete blood count
• Imaging studies
  • CT scan/MRI
  • Ultrasonography
• Other investigations
  • Function tests of intestinal absorption
    • D-xylose absorption
    • Schilling tests (I, II)
    • Bile acid breath test
  • Biopsy/barium study – identification of bowel abnormalities
  • Duodenal aspiration (giardia suspicion)
  • Serum gastrin (Zollinger-Ellison syndrome).

Steatorrhea Treatment

When it comes to steatorrhea, the treatment is concentrated on the underlying cause and not on the symptom per se. If the underlying cause is successfully treated, the symptomatology is going to improve as well. In some patients, digestive enzyme supplements can be administered, so as to improve the experienced symptoms.

In the situation that the patient suffers from a form of cancer, it is important to institute treatment as soon as possible (best survival rate). Chemotherapy and radiation therapy are among the treatment solutions that are recommended for such patients. If possible, the tumor can be surgically removed. If the steatorrhea is caused by liver cirrhosis, the only treatment available is the liver transplantation.

A dietary change is more than required for the patients who suffer from steatorrhea and other associated symptoms. Patients are advised to limit their fat intake, receiving replacements of pancreatic enzymes at the same time. These replacement pancreatic enzymes are also recommended in patients who suffer from chronic pancreatitis. Fat-soluble vitamins can also be administered, so as to help patients with chronic pancreatitis. Medium-chain triglycerides are recommended in patients who suffer from both steatorrhea and weight loss, while antibiotics are prescribed to those who suffer from bacterial infections at the level of the gastrointestinal tract. Last, but not least, if the steatorrhea is caused by bile acid malabsorption, bile acid sequesters such as cholestyramine can be administered.

How to Prevent Steatorrhea?

It is possible to prevent such health problems by maintaining an adequate diet, one that is rich in fresh fruits and vegetables, with a reduced fat intake. The alcohol intake should be reduced or even completely eliminated.

Are there any Complications of Steatorrhea?

Left untreated, the underlying conditions that have caused steatorrhea can lead to a number of complications. It is possible that these patients will suffer from anemia, intestinal obstruction and weight loss. If no treatment is undertaken in pediatric patients, these can suffer from failure to thrive and also from growth problems.