Steatorrhea
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Template:Search infobox Steatorrhea is the formation of non-solid feces. Stools may also float due to excess fat from malabsorption, have an oily appearance and be foul smelling. An oily anal leakage or some level of fecal incontinence may occur. There is increased fat excretion, which can be measured by determining the fecal fat level. While definitions have not been standardized, fat excretion in feces in excess of 0.3 (g/kg) / day is considered indicative of steatorrhea.
Possible biological causes
Possible biological causes can be lack of bile acids (due to liver damage or hypolipidemic drugs), defects in pancreatic juices (enzymes), and defective mucosal cells. The absence of bile acids will cause the feces to turn gray or pale.
Differential Diagnosis of Underlying Causes
- malabsorption, e.g. in inflammatory bowel disease, coeliac disease, and abetalipoproteinaemia
- exocrine pancreatic insufficiency
- chronic pancreatitis
- choledocholithiasis - (obstruction of the bile duct by a gallstone)
- pancreatic cancer - (if it obstructs biliary outflow)
- primary sclerosing cholangitis
- bacterial overgrowth
- short bowel syndrome
- cystic fibrosis
- Zollinger-Ellison syndrome
- giardiasis - a protozoan parasite infection
- Abuse or misuse of certain prescribed slimming pills.
As a side effect
Steatorrhea can also be due to eating non-digestible oils or fats such as Olestra, and a side-effect of medicines that prevent the absorption of dietary fats such as Orlistat,[1][2][3][4]
Artificial fats
The fat substitute Olestra, used in some reduced-fat foods, has been proven to cause leakage in some consumers. The United States Food and Drug Administration warning indicated that excessive consumption of Olestra could result in "loose stools"; this warning has not been required since 2003.[2][4]
Medications
Orlistat (Xenical) is a diet pill that works by blocking the enzymes that digest fat. As a result fat cannot be absorbed from the gut and some fat is excreted in the feces instead of being metabolically digested, sometimes causing oily anal leakage.[1][3]
Natural fats
Consuming Jojoba oil has been documented to cause steatorrhea and anal leakage because it is indigestible.[5]
Consuming escolar and oilfish (sometimes called butterfish) will often cause steatorrhea. The fish is commonly used in party catering due to its delicate flavor and the fact that it is cheap and readily available.
Treatment
Generally steatorrhea can be treated with prescription medicine and healthy diet. Performance status is often used as a measure to determine whether a patient can receive treatment, or whether dose reduction is required.
References
- ↑ 1.0 1.1 "Weighing a Pill For Weight Loss". Washington Post. Retrieved 2007-07-06.
While the Food and Drug Administration (FDA) still must approve the switch, the agency often follows the advice of its experts. If it does, Orlistat (xenical) -- currently sold only by prescription -- could be available over-the-counter (OTC) later this year. But it's important to know that the weight loss that's typical for users of the drug -- 5 to 10 percent of total weight -- will be less than many dieters expect. And many consumers may be put off by the drug's significant gastrointestinal side effects, including flatulence, diarrhea and anal leakage.
- ↑ 2.0 2.1 "Frito-Lay Study: Olestra Causes "Anal Oil Leakage"". Center for Science in the Public Interest. Thursday, February 13, 1997. Retrieved 2007-07-07.
The Frito-Lay report states: "The anal oil leakage symptoms were observed in this study (3 to 9% incidence range above background), as well as other changes in elimination. ... Underwear spotting was statistically significant in one of two low level consumer groups at a 5% incidence above background." Despite those problems, the authors of the report concluded that olestra-containing snacks "should have a high potential for acceptance in the marketplace."
Check date values in:|date=(help) - ↑ 3.0 3.1 "The Word Is 'Leakage'. Accidents may happen with a new OTC diet drug". Newsweek. June 25, 2007. Retrieved 2007-06-21.
GlaxoSmithKline has a tip for people who decide to try Alli, the over-the-counter weight-loss drug it is launching with a multimillion-dollar advertising blitz—keep an extra pair of pants handy. That's because Alli, a lower-dose version of the prescription drug Xenical, could (cue the late-night talk-show hosts) make you soil your pants. But while Alli's most troublesome side effect, anal leakage, is sure to be good for a few laughs, millions of people who are desperate to take off weight may still decide the threat of an accident is worth it.
- ↑ 4.0 4.1 "Reported medical side-effects of Olestra according to Procter and Gamble studies". Center for Science in the Public Interest. Retrieved 2007-06-21.
Olestra sometimes causes underwear staining associated with "anal leakage." Olestra sometimes causes underwear staining. That phenomenon may be caused most commonly by greasy, hard-to-wipe-off fecal matter, but occasionally also from anal leakage (leakage of liquid olestra through the anal sphincter).
- ↑ Comparative aspects of lipid digestion and absorption: physiological correlates of wax ester digestion
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