steatorrea

Steatorrhea is the excretion of abnormally large amounts of fat in the stool due to impaired fat digestion or absorption. The stools are typically bulky, pale, oily, and foul-smelling and may float. Patients often report that stools are difficult to flush and appear greasy.

Causes are diverse and include pancreatic exocrine insufficiency (such as chronic pancreatitis, cystic fibrosis, or pancreatic cancer), mucosal disorders of the small intestine (including celiac disease, Crohn disease, or tropical sprue), cholestasis or biliary obstruction reducing bile acids, infections (notably Giardia), post-surgical alterations (eg, bariatric or small bowel resection), and medication effects (such as orlistat). Bacterial overgrowth and certain rare metabolic conditions can also contribute.

Diagnosis starts with clinical suspicion in the presence of malabsorption signs and steatorrhea. The standard test is quantitative fecal fat analysis, typically a 72-hour stool collection showing fat excretion above about 7 g per day on a habitual diet. Additional tests may include fecal elastase-1 to assess pancreatic insufficiency, fat-soluble vitamin levels, celiac serology, and imaging or endoscopy to identify mucosal disease or biliary pathology.

Management focuses on treating the underlying cause and mitigating fat loss. Pancreatic enzyme replacement therapy (PERT) with meals is commonly used for pancreatic insufficiency, along with fat-soluble vitamin supplementation (A, D, E, K). Dietary adjustments may include a modestly reduced fat intake and, in some cases, use of medium-chain triglycerides. Prognosis varies by etiology; many patients improve with appropriate treatment, though persistent disease can lead to ongoing malnutrition.