Steatorrhoea

Steatorrhoea, also spelled steatorrhea, is the passage of bulky, pale, foul-smelling stools that tend to float. It results from fat malabsorption in the intestine or inadequate digestion of fats due to insufficient bile or pancreatic enzymes. The stool is typically greasy and may be difficult to flush, and patients may notice weight loss and signs of fat-soluble vitamin deficiency.

Common causes include pancreatic exocrine insufficiency (for example, chronic pancreatitis, pancreatic cancer, cystic fibrosis), diseases causing intestinal mucosal damage or intolerance (celiac disease, Crohn’s disease, infectious or inflammatory enteropathies such as giardiasis), biliary obstruction or cholestasis, and short bowel syndrome. Drugs that impair fat absorption can also contribute.

Clinical features extend beyond stool characteristics and may include bloating, abdominal cramps, steatorrhea with persistent diarrhea, and weight loss. Nutritonal deficiencies of fat-soluble vitamins (A, D, E, K) may occur, along with anemia or bone disease in some cases.

Diagnosis typically combines stool testing and clinical assessment. A qualitative or quantitative fecal fat measurement (e.g., 72-hour fecal fat collection) confirms fat malabsorption. Other tests include fecal elastase to evaluate pancreatic function, serology or biopsy for celiac disease, and imaging to identify biliary or pancreatic pathology. Additional tests may be guided by suspected underlying disease.

Management focuses on treating the underlying cause and replacing digestion as needed. Pancreatic enzyme replacement therapy, fat-soluble vitamin supplementation, and dietary adjustments (including moderate fat intake and, when appropriate, medium-chain triglycerides) are common approaches. Treatment of associated conditions (e.g., gluten-free diet for celiac disease, treatment of infections) is essential. Regular nutritional monitoring is important to prevent deficiency.