What is Steatorrhoea: Causes, Symptoms, Treatment, Complications, Prevention, Diagnosis

Presence of fat in the stool is medically known as Steatorrhoea. When a person has Steatorrhoea he/she has bulky stools, which float, with a greasy or oily or frothy appearance and foul smell. Steatorrhoea is not a disease in itself, but a symptom of an underlying condition. When the digestive system is not able to absorb the fat, then it excretes fat in the stool. Patient may also experience temporary Steatorrhoea from intestinal infections or changes in diet. Diseases of pancreas, biliary tract or intestines can also cause persistent Steatorrhoea.

Diseases Associated with Steatorrhoea: Common diseases which are related with steatorrhea are pancreatitis, cystic fibrosis, inflammatory bowel disease, exocrine pancreatic insufficiency, celiac disease, giardiasis, zollinger-ellison syndrome, Graves’ disease and tropical sprue.

Steatorrhoea is a symptom of problem with fat absorption in the intestines and this can occur due to both absorptive and digestive disorders in the body. The most common cause of steatorrhea is malabsorption of fats in the intestines, food, drugs and diseases which affect the pancreas and liver.

Absorption of fat depends on the bile, pancreatic lipases and normal intestine function. Absence of bile can occur from obstruction of the biliary tract, liver damage, pancreas removal and all this leads to hindrance in the fat absorption. Any type of digestive disorder affects the production and release of the vital enzymes which are required for digestion of fats in the intestines. Maldigestion and malabsorption of fat results in excretion of increased fats in the feces.

Some of the common causes of Steatorrhoea are:

• Biological causes such as bile acids, defective mucosal cells, defects in pancreatic enzymes etc. can also lead to steatorrhoea.
• ZES (Zollinger-Ellison Syndrome) is a condition which causes excessive production of stomach acids. This in turn hinders the function of enzymes that act on fats.
• Liver diseases, such as cirrhosis, hepatitis and liver inflammation, which inhibit the normal function of the liver, can also lead to Steatorrhoea.
• Intestinal causes. Intestinal stasis is one of the causes of steatorrhoea. This happens when the peristalsis is slow and leads to sluggish movement of the food in the intestines. This leads to bacterial overgrowth resulting in Steatorrhoea. Bacterial, viral or parasitic infection, bariatric surgery, celiac disease, food intolerances, inflammatory bowel disease and short-bowel syndrome can also cause Steatorrhoea.
• Biliary tract causes, such as biliary atresia, biliary stricture, cholangio-carcinoma and gallstones can also cause steatorrhea.
• Pancreatic causes including congenital pancreatic lipase deficiency, cystic fibrosis, pancreatitis and pancreatic cancer can also cause steatorrhea.

• Patient has bulky and pale colored stool.
• The stool is foul smelling, loose/frothy and oily/greasy in appearance.
• Rapid weight loss in a few months.
• Patient also has pruritus (itching) of the body.
• Jaundice where there is yellowing of the white of the eyes and skin.
• Loose stools.
• There may be blood in the stool.
• Cough.
• Patient also has abdominal distension and pain.
• There is also nausea.
• Rumbling noises can be heard in the stomach along with presence of flatulence.
• Dark colored urine.
• Patient also has diarrhea.

Serious Symptoms of Steatorrhoea

The following symptoms along with Steatorrhoea can indicate a life threatening condition and needs immediate medical attention:

• Bloody stool, which can be black, red and tarry.
• Chest tightness, chest pressure, chest pain or palpitations.
• Changes in the level of alertness or consciousness, such as unresponsiveness or losing consciousness.
• High fever.
• Decreased production of urine or absence of urine.
• Breathing or respiratory problems, such as difficulty breathing, shortness of breath or labored breathing
• Abdominal rigidity.
• Severe/sharp pain in the abdomen which starts suddenly.

Pancreatic Insufficiency Steatorrhoea: This is the most common form of Steatorrhoea, which occurs due to insufficient enzymes in the body. Decrease in lipase and colipase leads to exocrine pancreatic insufficiency, which ultimately causes pancreatic insufficiency steatorrhea.

Bile Salt Deficiency Steatorrhoea: This type of steatorrhea occurs as a result of bile deficiency due to impaired release of bile salts.

Malabsorption Steatorrhoea: This type of steatorrhea occurs as a result of a small intestine disorder, medication or surgery.

Stool testing needs to be done to confirm steatorrhoea. Patients with mild cases of steatorrhoea will have a normal or healthy appearing stool with very mild or absent signs of steatorrhoea. It takes around 72 hours for stool analysis, as the patient has to submit his/ her stool of 100g in a day for three days consecutively. If the quantity of bad fat is more than 14g each day, then it indicates that the patient has steatorrhea due to malabsorption.

Treatment of steatorrhea is done by treating the underlying cause of it. Digestive enzyme supplements can be given to help with the treatment. Some of the treatment methods for steatorrhoea are:

Restricting the fat intake: The primary and the first line of treatment of steatorrhea is cutting down the amount of fats in the diet. Following a diet which contains less fat will help in improving the steatorrhea, as this condition has excess fat in the stool.

Antibiotics: If the cause of steatorrhea is intestinal bacterial overgrowth or bacterial infection, then antibiotics are prescribed.

Supplementary Pancreatic Enzymes: In some cases, cutting the number of fats in the diet does not give much improvement, in such cases supplementary pancreatic enzymes taken with meals help. It is important that they should not be taken before or after the meals and taken with meals only.

Decrease in alcohol intake: Reduction or complete abstinence from alcohol is recommended if the cause of steatorrhea is an alcohol condition.

Medium-Chain Triglycerides Supplements: In case where the supplementary pancreatic enzymes are not working then medium chain triglycerides can be given as supplements, as these are excellent alternatives because they do not need any enzymes to get absorbed into the blood.

Folic Acid Therapy: Patients who suffer from Sprue benefit from folic acid therapy. Foods rich in folic acid, such as asparagus, kale, broccoli and spinach can be consumed.

Fat-Soluble Vitamins: If the steatorrhea is present in a patient who is suffering from chronic pancreatitis, then fat-soluble vitamins, such as A, D, E, and K will be added or increased to the diet.

Steatorrhoea can be due to some serious underlying medical problem. If this is not treated, then serious complications can occur, which include:

• Anemia.
• Frequent serious infections.
• Growth problems in children.
• Obstruction of intestine and rupture of the wall of intestine.
• Metastasis of cancer.
• Poor nutrition due to appetite loss, diarrhea or vomiting.
• Spreading of infection.
• Serious infection or malignant condition, which requires surgery to remove some part of the digestive tract.

Excessive intake of alcohol causes steatorrhea, so it should be avoided. Alcohol causes cirrhosis of the liver, which leads to the liver being hampered from producing the essential enzymes, which are required for fat digestion in the body. Abstinence from alcohol or reduction in alcohol helps in decreasing the chances of steatorrhea.

Patient should also cut down on the amount of fats in the diet. As steatorrhea results from incomplete absorption and incomplete digestion resulting in excessive fats in the stool, thus it is important to follow a low fat diet to prevent steatorrhea.

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