From the Guidelines
Steatorrhea is primarily caused by pancreatic exocrine insufficiency, where the pancreas does not produce enough enzymes to break down dietary fats, leading to excess fat in the stool. This condition can also be caused by other factors such as mucosal disease, structural disorders, or small intestinal bacterial overgrowth (SIBO) 1.
Causes of Steatorrhea
- Pancreatic exocrine insufficiency: This is the most common cause of severe steatorrhea, where the pancreas does not produce enough enzymes to break down dietary fats 1.
- Mucosal disease: Conditions such as celiac disease, Crohn's disease, or other inflammatory bowel diseases can cause steatorrhea by damaging the intestinal lining and impairing fat absorption 1.
- Structural disorders: Conditions such as small intestinal dysmotility or intestinal obstruction can cause steatorrhea by impairing the normal movement and mixing of food in the intestine 1.
- Small intestinal bacterial overgrowth (SIBO): This condition occurs when excess bacteria are present in the small intestine, leading to the breakdown of dietary fats and the production of toxic compounds that can cause steatorrhea 1.
Diagnosis and Treatment
- Diagnosis: Steatorrhea can be diagnosed through stool fat tests, blood tests, and possibly endoscopy 1.
- Treatment: Treatment depends on the underlying cause of steatorrhea, and may include pancreatic enzyme replacement therapy (PERT), a strict gluten-free diet, bile acid sequestrants, or antibiotics such as rifaximin 1.
Management
- Dietary modifications: Reducing fat intake and using medium-chain triglyceride oils may help manage symptoms of steatorrhea while addressing the underlying condition 1.
- Antibiotic therapy: Antibiotics such as rifaximin may be used to treat SIBO and reduce symptoms of steatorrhea 1.
From the Research
Causes of Steatorrhea
- Steatorrhea is caused by malabsorption due to severe pancreatic exocrine insufficiency, which is a late feature of chronic pancreatitis 2
- The lack of pancreatic lipase activity is not compensated for by nonpancreatic mechanisms, leading to impaired lipid digestion and steatorrhea 2
- Exocrine pancreatic insufficiency is a major consequence of chronic pancreatitis, and steatorrhea is a common symptom 3
Associated Conditions
- Steatorrhea is associated with conditions such as lactose intolerance, celiac disease, and exocrine pancreatic insufficiency 4
- Malabsorption syndromes, including steatorrhea, can be caused by a wide range of conditions, including chronic pancreatitis, gluten enteropathy, and short-bowel syndrome 5
Pathophysiology
- The synthesis and secretion of lipase are impaired more rapidly in chronic pancreatitis, leading to steatorrhea 2
- The intraluminal survival of lipase is shorter, and the lack of pancreatic lipase activity is not compensated for by nonpancreatic mechanisms, contributing to steatorrhea 2
- Factors such as an acidic intestinal pH and bacterial overgrowth may prevent normalization of fat digestion even in compliant patients 3