STEATORRHEA: SYMPTOMS, CAUSES, CONSEQUENCES, PREVENTION - MEDICINE - 2024

The steatorrhea is the elimination of feces with a high fat content, which generates loose stools, foaming, usually light colored floating in the water of the toilet. Bowel movements may increase in volume and frequency.

In some patients the characteristics of the stool are not so flowery; Therefore, to confirm the diagnosis, the patient is put on a diet rich in fat (50 to 150 g / day) and all the feces are collected for three days.

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Subsequently, the total fat content is measured, calculating the daily average: if the values ​​are greater than 7 g per day, it is said that there is steatorrhea.

The lipids are absorbed in the small intestine, but the stomach starts the process of agitating the mixture. When this mixture enters the small intestine, the bile is added and consequently an emulsion is produced.

This emulsion is subjected to the action of lipases, phospholipases and hydrolases secreted by the pancreas into the duodenum.

Bile promotes the formation of micelles, which are water-soluble and incorporate fats inside, which facilitates the action of pancreatic enzymes. The water-soluble micelles are easily transported to the intestinal wall, where they are absorbed.

As a result of the enzymatic action, free fatty acids, monoglycerides, and short and long chain fatty acids are formed. Free fatty acids, monoglycerides and short-chain fatty acids (less than 12 carbon atoms) are absorbed and pass into the portal circulation to the liver.

Long-chain fatty acids are re-esterified and together with fat-soluble vitamins (A, D, E and K) and cholesterol are absorbed by the lymphatic pathway, forming chylomicrons. Chylomicrons are lipoproteins packaged by the cells of the intestinal mucosa for absorption, which end up being metabolized in the liver.

Any alteration of the processes that involve the digestion and absorption of fats can potentially cause steatorrhea. Too much fat intake or eating foods high in fiber, for example, can reduce absorption and increase fat excretion in the stool.

Symptoms of steatorrhea

The main symptoms of steatorrhea are increased volume and frequency of loose, clear, foamy, and foul-smelling stools. Sometimes they present as frank diarrhea with increased fluid elimination, flatulence, and abdominal pain.

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Concomitantly the patient presents the signs and symptoms of the disease that causes steatorrhea.

As a consequence of steatorrhea and its duration, weight loss, electrolyte deficiency, vitamin deficiency, decreased muscle mass, fatigue, weakness and general malaise can occur.

Causes

Steatorrhea can have a number of causes, including:

- Food

- Poor intestinal absorption due to problems of the intestinal wall

- Pancreatic problems and / or bile formation and secretion

- Intestinal parasites or bacteria that interfere with absorption.

- Drugs that interfere with fat absorption by inhibiting lipases

Food

The dietary causes of steatorrhea include the excessive consumption of foods rich in fat, especially when combined with fiber. In these cases, excess or fat that cannot be metabolized and absorbed is eliminated in the stool, which can lead to steatorrhea.

Fatty food example (Image by Larry White at www.pixabay.com)

Under these conditions there is no intestinal malabsorption, but elimination of an excess that cannot be handled by the small intestine or that, due to the presence of foods with many indigestible fibers, is washed away and eliminated with the feces.

Steatorrhea in these cases is sporadic and is directly related to the fat content of the food eaten. By changing the feeding pattern, steatorrhea disappears.

Poor intestinal absorption due to problems of the intestinal wall

Among the diseases that can affect the wall of the small intestine, produce malabsorption and therefore steatorrhea, we can name:

- Crohn's disease, a disease that is accompanied by an inflammatory process of the gastrointestinal tract

- Short bowel syndrome as a consequence of major surgical resections of the small intestine

- Genetic diseases that affect the structure of the wall of the small intestine

- Tropical sprue, a disease that occurs in tropical or subtropical areas that is accompanied by alterations of the intestinal mucosa and malabsorption syndrome

- Radiation damage

Pancreatic problems and / or bile formation and secretion

Problems with the exocrine pancreas and with the formation or release of bile are one of the most common causes of steatorrhea.

Exocrine pancreas pathologies fundamentally affect fat metabolism, since other areas of the gastrointestinal tract can participate in the digestion of proteins and carbohydrates, but no other area of ​​the intestine can produce lipases.

Among the diseases that cause deficits in pancreatic function and the biliary system can be named:

- Cystic fibrosis, a hereditary disease that affects the exocrine glandular system, including the exocrine pancreas and other organs such as the lung.

- Chronic pancreatitis, diseases characterized by steatorrhea and weight loss, among other clinical manifestations.

- Tumors of the pancreas and surgical resections of this organ.

- Advanced liver failure that affects bile production.

- Obstructive problems of the biliary secretion system.

Intestinal parasites or bacteria that interfere with absorption

The intestinal parasite Giardia lamblia is a protozoan that can invade the mucosa of the small intestine and cause significant lesions in said mucosa.

These lesions produce a syndrome of intestinal malabsorption, especially with disorders in the digestion and absorption of fats, which translates into steatorrhea.

Whipple's disease, caused by Tropheryma whippelii, an actinomyces (commensal germ of the digestive mucosa), also causes malabsorption and steatorrhea.

Medications that interfere with fat absorption by inhibiting lipases

Orlistat or tetrahydrolipstatin is a drug used to control obesity. It is an inhibitor of pancreatic lipase, which prevents the absorption of fats and causes intense steatorrhea.

Consequences

As a consequence of steatorrhea, when the process is prolonged, there is weight loss and manifestations related to the lack of absorption of some substances such as fat-soluble vitamins and folates, mainly.

Lack of vitamin A is related to night blindness, while vitamin D deficiency is related to deficit in calcium absorption, demineralization of bones, osteoporosis, bone pain, and frequent fractures.

Vitamin K deficiency affects the blood coagulation system, increasing prothrombin time, promoting the appearance of petechiae and spontaneous hematomas. Vitamin E deficiencies have uncertain effects, but can cause testicular atrophy and neurological defects in boys.

Folate deficits are related to the appearance of anemia due to decreased production of red blood cells.

Prevention

The best way to prevent vitamin deficiencies caused by fat malabsorption syndrome is to replace commonly used fats with medium chain triglycerides in the diet, for which the use of coconut oil is very popular.

However, vitamins K, D, and A can be provided parenterally.

You should reduce total fat consumption, avoid fried foods, aged cheeses, meats with high fat content, etc. Meals should be divided into smaller portions and, above all, treat the cause of steatorrhea.

References

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