Steatorrhea(orsteatorrhoea) is the presence of excessfatinfeces.Stools may be bulky and difficult to flush, have a pale and oily appearance, and can be especially foul-smelling.[1]An oily anal leakage or some level offecal incontinencemay occur. There is increased fat excretion, which can be measured by determining the fecal fat level.[2]
Steatorrhea | |
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Specialty | Gastroenterology,general surgery |
Causes
editImpaired digestion or absorption can result in fatty stools. Possible causes includeexocrine pancreatic insufficiency,with poor digestion from lack oflipases,loss ofbile salts,which reducesmicelleformation, and small intestinal disease-producingmalabsorption.Various other causes include certain medicines that block fat absorption or indigestible or excess oil/fat in diet.[2]
The absence ofbilesecretion 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.[2]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.[1]
Associated diseases
edit- Conditions affecting thepancreas.Exocrine pancreatic insufficiency[3]can be caused by chronicpancreatitis,cystic fibrosisandpancreatic cancer(if it obstructs biliary outflow).[1]
- Conditions affectingbile salts.Obstruction of thebile ductsbygallstones(choledocholithiasis),primary sclerosing cholangitis,liver damage(hepatitis,intrahepaticcholestasis),hypolipidemicdrugs, or changes followinggallbladderremoval (cholecystectomy).[1]
- Conditions producing intestinalmalabsorption.These includeceliac disease,bacterial overgrowth,tropical sprue,giardiasis(a protozoan parasite infection),Zollinger-Ellison syndrome,short bowel syndrome,inflammatory bowel diseaseandabetalipoproteinemia.[1][4]
- Other causes: Drugs that can produce steatorrhea includeorlistat,a slimming pill, or as adverse effect ofoctreotideorlanreotide,used to treatacromegalyor otherneuroendocrine tumors.[5]It can be found inGraves' disease/hyperthyroidism.[1]
Medications
editOrlistat(also known by trade names Xenical and Alli) is a diet pill that works by blockingthe 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.[6][7][8]Vytorin (ezetimibe/simvastatin) tablets can cause steatorrhea in some people.[6][8]
Excess whole nuts in diet
editSome studies have shown that stool lipids are increased when whole nuts are eaten, compared to nut butters, oils or flour[9]and that lipids from whole nuts are significantly less well absorbed.[10]
Natural fats
editConsumingjojoba oilhas been documented to cause steatorrhea and anal leakage because it is indigestible.[11]
Consumingescolarandoilfish(sometimes mislabelled asbutterfish) will often cause steatorrhea, also referred to as gempylotoxism or gempylid fish poisoning orkeriorrhea.[12]
Artificial fats
editThe fat substituteOlestra,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 Administrationwarning indicated excessive consumption of Olestra could result in "loose stools"; however, this warning has not been required since 2003.[7][13]
Diagnosis
editSteatorrhea should be suspected when the stools are bulky, floating and foul-smelling.[1]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).[14]Other tests include the (13)C-mixed triglycerides test and fecalelastase,to detect possible fat maldigestion due toexocrine pancreatic insufficiency,[14]or various specific tests to detect other causes ofmalabsorptionsuch asceliac disease.[15]
Treatment
editTreatments are mainly correction of the underlying cause, as well as digestive enzyme supplements.[2]
See also
editReferences
edit- ^abcdefgAdam S Cheifetz, Alphonso Brown, Michael Curry, Alan C Moss (10 Mar 2011).Oxford American Handbook of Gastroenterology and Hepatology.Oxford University Press. p. 234.ISBN978-0-19-983012-1.
- ^abcdAzer SA, Sankararaman S (January 2021).Steatorrhea.Treasure Island (FL): StatPearls Publishing.PMID31082099.Retrieved3 October2021.
- ^Lindkvist B (2013)."Diagnosis and treatment of pancreatic exocrine insufficiency".World J. Gastroenterol.(Review).19(42): 7258–66.doi:10.3748/wjg.v19.i42.7258.PMC3831207.PMID24259956.
- ^Moutzouri E, Elisaf M, Liberopoulos NE (2011). "Hypocholesterolemia".Current Vascular Pharmacology.9(2): 200–12.doi:10.2174/157016111794519354.PMID20626336.
- ^Dogliotti L, Tampellini M, Stivanello M, Gorzegno G, Fabiani L (2001). "The clinical management of neuroendocrine tumors with long-acting repeatable (LAR) octreotide: comparison with standard subcutaneous octreotide therapy".Annals of Oncology.12(Suppl 2): S105–9.doi:10.1093/annonc/12.suppl_2.s105.PMID11762334.
- ^abSquires S (2006-01-24)."Weighing a Pill For Weight Loss".Washington Post.Retrieved2007-07-06.
While the Food and Drug Administration (FDA) still must approve the switch, the agency often follows the advice of its experts. If it does, Orlistat (xenical) -- currently sold only by prescription -- could be available over-the-counter (OTC) later this year. But it's important to know that the weight loss that's typical for users of the drug -- 5 to 10 percent of total weight -- will be less than many dieters expect. And many consumers may be put off by the drug's significant gastrointestinal side effects, includingflatulence,diarrhea,and anal leakage.
- ^ab"Frito-Lay Study: Olestra Causes" Anal Oil Leakage "".Center for Science in the Public Interest.February 13, 1997. Archived fromthe originalon 2016-06-18.Retrieved2007-07-07.
The Frito-Lay report states: "The anal oil leakage symptoms were observed in this study (3 to 9% incidence range above background), as well as other changes in elimination.... Underwear spotting was statistically significant in one of two low-level consumer groups at a 5% incidence above background." Despite those problems, the authors of the report concluded that olestra-containing snacks "should have a high potential for acceptance in the marketplace."
- ^ab"The Word Is 'Leakage'. Accidents may happen with a new OTC diet drug".Newsweek.June 25, 2007. Archived fromthe originalon 2007-06-18.Retrieved2007-06-21.
GlaxoSmithKline has a tip for people who decide to try Alli, the over-the-counter weight-loss drug it is launching with a multimillion-dollar advertising blitz—keep an extra pair of pants handy. That's because Alli, a lower-dose version of the prescription drugXenical,could (cue the late-night talk-show hosts) make you soil your pants. But while Alli's most troublesome side effect, anal leakage, is sure to be good for a few laughs, millions of people who are desperate to take off weight may still decide the threat of an accident is worth it.
- ^Traoret CJ, Lokko P, Cruz AC, Oliveira CG, Costa NM, Bressan J, Alfenas RC, Mattes RD (2007)."Peanut digestion and energy balance".International Journal of Obesity.32(2): 322–8.doi:10.1038/sj.ijo.0803735.PMID17912269.
- ^Hollis J, Mattes R (2007)."Effect of chronic consumption of almonds on body weight in healthy humans".British Journal of Nutrition.98(3): 651–6.doi:10.1017/S0007114507734608.PMID17445351.
- ^Place AR (1992). "Comparative aspects of lipid digestion and absorption: Physiological correlates of wax ester digestion".The American Journal of Physiology.263(3 Pt 2): R464–71.doi:10.1152/ajpregu.1992.263.3.R464.PMID1415629.
- ^Bad Bug Book- Foodborne Pathogenic Microorganisms and Natural Toxins Handbook:Gempylotoxin,FDA
- ^"Reported medical side-effects of Olestra according to Procter and Gamble studies".Center for Science in the Public Interest.Archived fromthe originalon 2007-07-02.Retrieved2007-06-21.
Olestra sometimes causes underwear staining associated with "anal leakage." Olestra sometimes causes underwear staining. That phenomenon may be caused most commonly by greasy, hard-to-wipe-off fecal matter, but occasionally also from anal leakage (leakage of liquid olestra through the anal sphincter).
- ^abLindkvist B (14 November 2013)."Diagnosis and treatment of pancreatic exocrine insufficiency".World Journal of Gastroenterology.19(42): 7258–66.doi:10.3748/wjg.v19.i42.7258.PMC3831207.PMID24259956.
- ^Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA, American College of G (May 2013)."ACG clinical guidelines: diagnosis and management of celiac disease".The American Journal of Gastroenterology.108(5): 656–76, quiz 677.doi:10.1038/ajg.2013.79.PMC3706994.PMID23609613.