Steatorrhea

Template:Short description Template:Cs1 config Template:Infobox medical condition (new) Steatorrhea (or steatorrhoea) is the presence of excess fat in feces. Stools may be bulky and difficult to flush, have a pale and oily appearance, and can be especially foul-smelling.<ref name="Handbook">Template:Cite book</ref> An oily anal leakage or some level of fecal incontinence may occur. There is increased fat excretion, which can be measured by determining the fecal fat level.<ref name="StatPearls"/>

Causes

Impaired digestion or absorption can result in fatty stools. Possible causes include exocrine pancreatic insufficiency, with poor digestion from lack of lipases, loss of bile salts, which reduces micelle formation, and small intestinal disease-producing malabsorption. Various other causes include certain medicines that block fat absorption or indigestible or excess oil/fat in diet.<ref name="StatPearls"/>

The absence of bile secretion can cause the feces to turn gray or pale. Bile is responsible for the brownish color of feces. In addition to this, bile also plays a role in fat absorption, where dietary lipids are combined so that pancreatic lipases can hydrolyze them before going towards the small intestine. Without bile acids, this pathway would have a hard time occurring, which would lead to fat malabsorption and make steatorrhea more probable to occur.<ref name="StatPearls"/> Other features of fat malabsorption may also occur such as reduced bone density, difficulty with vision under low light levels, bleeding, bruising, and slow blood clotting times.<ref name="Handbook"/>

Associated diseases

• Conditions affecting the pancreas. Exocrine pancreatic insufficiency<ref name="pmid24259956">Template:Cite journal</ref> can be caused by chronic pancreatitis, cystic fibrosis and pancreatic cancer (if it obstructs biliary outflow).<ref name="Handbook"/>
• Conditions affecting bile salts. Obstruction of the bile ducts by gallstones (choledocholithiasis), primary sclerosing cholangitis, liver damage (hepatitis, intrahepatic cholestasis), hypolipidemic drugs, or changes following gallbladder removal (cholecystectomy).<ref name="Handbook"/>
• Conditions producing intestinal malabsorption. These include celiac disease, bacterial overgrowth, tropical sprue, giardiasis (a protozoan parasite infection), Zollinger-Ellison syndrome, short bowel syndrome, inflammatory bowel disease and abetalipoproteinemia.<ref name="Handbook"/><ref name="pmid20626336">Template:Cite journal</ref>
• Other causes: Drugs that can produce steatorrhea include orlistat, a slimming pill, or as adverse effect of octreotide or lanreotide, used to treat acromegaly or other neuroendocrine tumors.<ref>Template:Cite journal</ref> It can be found in Graves' disease / hyperthyroidism.<ref name="Handbook"/>

Medications

Orlistat (also known by trade names Xenical and Alli) is a diet pill that works by blocking the enzymes that digest fat. As a result, some fat cannot be absorbed from the gut and is excreted in the feces instead of being metabolically digested and absorbed, sometimes causing oily anal leakage.<ref name=WP>Template:Cite news</ref><ref name=CSPI>Template:Cite news</ref><ref name=NW>Template:Cite news</ref> Vytorin (ezetimibe/simvastatin) tablets can cause steatorrhea in some people.<ref name=WP/><ref name=NW/>

Excess whole nuts in diet

Some studies have shown that stool lipids are increased when whole nuts are eaten, compared to nut butters, oils or flour<ref>Template:Cite journal</ref> and that lipids from whole nuts are significantly less well absorbed.<ref>Template:Cite journal</ref>

Natural fats

Consuming jojoba oil has been documented to cause steatorrhea and anal leakage because it is indigestible.<ref>Template:Cite journal</ref>

Consuming escolar and oilfish (sometimes mislabelled as butterfish) will often cause steatorrhea, also referred to as gempylotoxism or gempylid fish poisoning or keriorrhea.<ref>Bad Bug Book - Foodborne Pathogenic Microorganisms and Natural Toxins Handbook: Gempylotoxin, FDA</ref>

Artificial fats

The fat substitute Olestra, used to reduce digestible fat in some foods, was reported to cause leakage in some consumers during the test-marketing phase. As a result, the product was reformulated before general release to a hydrogenated form that is not liquid at physiologic temperature. The U.S. Food and Drug Administration warning indicated excessive consumption of Olestra could result in "loose stools"; however, this warning has not been required since 2003.<ref name=CSPI/><ref name=CSPI2>Template:Cite news</ref>

Diagnosis

Steatorrhea should be suspected when the stools are bulky, floating and foul-smelling.<ref name="Handbook"/> Specific tests are needed to confirm that these properties are in fact due to excessive levels of fat. Fats in feces can be measured over a defined time (often five days).<ref name="PMID24259956">Template:Cite journal</ref> Other tests include the (13)C-mixed triglycerides test and fecal elastase, to detect possible fat maldigestion due to exocrine pancreatic insufficiency,<ref name="PMID24259956"/> or various specific tests to detect other causes of malabsorption such as celiac disease.<ref>Template:Cite journal</ref>

Treatment

Treatments are mainly correction of the underlying cause, as well as digestive enzyme supplements.<ref name="StatPearls">Template:Cite book</ref>

See also

• Rectal discharge
• Keriorrhea
• Fecal leakage
• Steatocrit