From the Guidelines
Steatorrhea is primarily caused by malabsorption of fats in the digestive system, with the most recent and highest quality evidence suggesting that pancreatic insufficiency, bile acid deficiency, celiac disease, Crohn's disease, and small intestinal bacterial overgrowth (SIBO) are common causes 1. This condition occurs when the body cannot properly absorb dietary fats, leading to excess fat in the stool, which appears pale, bulky, greasy, and foul-smelling. Some key points to consider include:
- Pancreatic insufficiency, where the pancreas doesn't produce enough digestive enzymes, is a common cause of steatorrhea, as seen in chronic pancreatitis 1.
- Bile acid deficiency, due to liver disease or gallbladder removal, can also lead to steatorrhea, as bile acids are essential for emulsifying fats for absorption 1.
- Celiac disease, which damages intestinal villi, can cause malabsorption of fats and lead to steatorrhea, and a gluten-free diet is essential for managing this condition 1.
- Crohn's disease and SIBO can also cause steatorrhea, and treatment may involve addressing the underlying condition, such as with antibiotics or anti-inflammatory medications 1.
- Certain medications that interfere with fat absorption can also cause steatorrhea, and treatment may involve adjusting the medication regimen or adding supplements to support fat absorption 1. Treatment depends on the underlying cause but often includes pancreatic enzyme supplements (like pancrelipase) for pancreatic insufficiency, taken with meals at doses determined by a healthcare provider. A low-fat diet may help manage symptoms while addressing the root cause. For celiac disease, a gluten-free diet is essential. Bile acid sequestrants might be prescribed for bile acid malabsorption. Steatorrhea occurs because proper fat digestion requires adequate pancreatic enzymes to break down fats and sufficient bile acids to emulsify them for absorption through the intestinal wall. When this process is disrupted at any point, undigested fat passes through the digestive tract, resulting in the characteristic fatty stools.
From the Research
Causes of Steatorrhea
Steatorrhea, which is the presence of excess fat in the feces, can be caused by various factors. Some of the common causes include:
- Pancreatic insufficiency, which can be caused by chronic pancreatitis 2, 3, 4
- Celiac disease, also known as gluten enteropathy 2, 5
- Short-bowel syndrome 2
- Cystic fibrosis 2
- Exocrine pancreatic insufficiency 5, 4
- Lactose intolerance 5
- Nonceliac gluten sensitivity 5
- Irritable bowel syndrome 5
- Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) intolerance 5
Disease Entities Associated with Steatorrhea
The most common disease entities causing steatorrhea are discussed in detail in various studies 2, 3, 5, 4. These studies emphasize the importance of understanding the cause of steatorrhea in order to adopt an appropriate approach to dietary management.
Diagnostic Significance of Fecal Fat
The diagnostic significance of the Sudan III staining for fecal fat has been evaluated in a study 6. The results showed that the quantitative relationship between the number of fecal fat droplets examined microscopically and the amount of the fecal fat determined chemically was significant. However, the study also noted that there were false positive and false negative cases, highlighting the importance of careful interpretation of the results.