HEALTHNET

What is steatorrhea?

Steatorrhea is caused by poor digestion or absorption of dietary fat.

(Posted on 25 January 2007)

Q1. What is steatorrhea?

A1. Steatorrhea is a form of chronic diarrhea where the patient passes loose, pale, greasy, bulky and offensive stools that float on water. This is caused by excessive fat content in the stool. Cleansing the toilet-pan would take several flushes.

Steatorrhea is caused by poor digestion or absorption of dietary fat. Our body has a sophisticated mechanism to digest and absorb ingested fat. A diet rich in fat would stimulate the secretion of bile into the small intestine. Acting like a detergent, bile acid in the bile would emulsify the fat and dissolve it into the intestinal juice. An enzyme called lipase secreted by the pancreas would then break down the fat into smaller molecules (such as fatty acids and cholesterol), which are transported into the cells lining the small intestine, again with the aid of bile acids.

A patient with steatorrhea may show signs of general malnutrition, such as loss of weight, lack of energy and deterioration in overall health. Children may suffer from poor growth and have frequent infections. The patient may look pale from anemia and the abdomen is often distended. The skin may look dry and the lips and tongue are sore because of vitamin deficiency.

Q2. What are the causes of steatorrhea?

A2. Steatorrhea can be caused by diseases affecting liver, the pancreas, or the small intestine.

1.Disorders of the liver

Steatorrhea is a frequent complaint in patients with chronic liver diseases who have problem in secreting bile. These patients are often severely jaundiced (look yellow).

2.Diseases of the pancreas

Pancreatitis is the inflammation of the pancreas. If chronic, the condition can cause steatorrhea when the ability to secrete lipase (the enzyme that digests fat) is impaired. Steatorrhea is also common in cystic fibrosis, which is a genetic condition that causes the body to produce excessively thick, sticky mucus that clogs the lungs and pancreas. Steatorrhea is also common in patients who have their pancreas surgically removed.

3.Small intestine problems

Steatorrhea occurs in patients with Celiac disease, who are unable to tolerate a protein in wheat and rye. The protein can cause extensive damage to cells lining the small intestine. Digestion and absorption of fat are therefore severely impaired. Steatorrhea can also occur in a patient whose small intestine is surgically removed, is extensively diseased, or is colonized by bacterial overgrowth.

Q3. How is steatorrhea treated?

A3. Steatorrhea is only a symptom. Doctors would also order blood tests to review the nutritional state and perform tests for malabsorption. Depending on the situation, radiological examinations, endoscopies, or even biopsies may be necessary. The condition must be thoroughly evaluated before treatment can be recommended since different underlying causes would require different treatment regimes.

In Celiac disease, steatorrhea would recover when wheat and rye proteins are excluded from the diet (gluten-free diet). Patients with bacterial overgrowth of the small bowels may recover with antibiotic treatment. Patients with pancreatic secretion problem may benefit from ingested pancreatic enzymes. Ingested enzymes would not be effective if they are digested by stomach acid. This problem can be partially solved by using "enteric coated" preparations which only releases the enzymes after the swallowed tablet has passed the stomach.

Patients with steatorrhea may need to limit their dietary fat intake. Since a certain amount of fat is necessary for normal growth and development, an alternative called "medium chain triglyceride" can be used as a source of fat in the diet. Since they are absorbed from the gut through another channel different from other fats, symptoms of steatorrhea are avoided.

Source: Quality HealthCare