Steatorrhea

Steatorrhea (or steatorrhoea) is the presence of excess fat in feces. Stools may also float due to excess gas, have an oily appearance and can be especially foul-smelling.^[1] 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. The definition of how much fecal fat constitutes steatorrhea has not been standardized.

Causes

Possible biological causes can be lack of bile acids (due to liver damage, hypolipidemic drugs, or gallbladder removal (cholecystectomy)), defects in pancreatic enzymes, defective mucosal cells, certain medicines that block fat absorption, or indigestible or excess oil/fat in diet. The absence of bile acids will cause the feces to turn gray or pale. Another cause of steatorrhea is due to the adverse effect of octreotide or lanreotide, which are analogs of somatostatin, used clinically to treat acromegaly.

Associated diseases

• Malabsorption, e.g. in inflammatory bowel disease, celiac disease, and abetalipoproteinemia^[2][3]
• Exocrine pancreatic insufficiency
• Pancreatitis
• Choledocholithiasis (obstruction of the bile duct by a gallstone)
• Pancreatic cancer (if it obstructs biliary outflow)
• Primary sclerosing cholangitis
• Bacterial overgrowth
• Short bowel syndrome
• Cystic fibrosis
• Celiac Disease
• Zollinger-Ellison syndrome
• Giardiasis (a protozoan parasite infection)
• Graves' disease / hyperthyroidism
• Abuse or misuse of certain prescribed slimming pills (such as Orlistat)
• Tropical sprue

In patients with steatorrhea, other associated symptoms may include reduced bone density, difficulty with vision under low light levels, and slow blood clotting times.

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, sometimes causing oily anal leakage.^[4][5][6] VYTORIN® (ezetimibe/simvastatin) tablets can cause Steatorrhea in some people.^[4][6]

Excess whole nuts in diet

There are anecdotal reports on the internet describing oily droplets in feces after eating large amounts of cashews or other whole nuts.^[7][8] They agree with studies showing that stool lipids are greatest when whole nuts are eaten, compared to their nut butters, oils or flour^[9] and that lipids from whole nuts are significantly less well absorbed.^[10]

Natural fats

Consuming jojoba oil has been documented to cause steatorrhea and anal leakage because it is indigestible.^[11]

Consuming escolar and oilfish (sometimes called butterfish) will often cause steatorrhea, also referred to as Gempylotoxism or Gempylid Fish Poisoning or keriorrhea.^[12] The fish is commonly used in party catering due to its delicate flavor and because it is cheap and readily available.

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.^[5][13]

Treatment

Treatments are mainly correction of the underlying cause, as well as digestive enzyme supplements.^[14]

See also

• Rectal discharge
• Keriorrhea
• Fecal leakage

References