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Steatorrhea
Definition
Steatorrhea is the passage of fat > 6 g/24 hr stools. Confirmed by repeating
the test for 3 consecutive days.
The 1st step after proving steatorrhea is to differentiate between
absorptive abnormality and digestive abnormality. This is done by the
D-xylose test. D-xylose is a sugar that does not need to be digested (but
needs to be absorbed to appear in urine). Hence if urinary excretion is
low this infers an absorptive cause for steatorrhea.
1. Malabsorption
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Low D-xylose in urine
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Jejunal disease
- Bacterial overgrowth (breath test)
- Celiac disease
- Dermatitis herpetiformis
- Tropical sprue
- Intestinal resection
- Whipple's disease
- Radiation enteritis
- Parasitic infestation (Giardia
lamblia)
- Primary lactase deficiency
- Intestinal lymphoma
- Intestinal lymphangiectasia
- Crohn's disease
- Intestinal ischaemia
Bacterial overgrowth is diagnosed by a breath test. Some diseases may
require a jejunal biopsy.
2. Maldigestion
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Normal D-xylose in urine
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1. Pancreatic insufficiency
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+ve Benteromide test
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- Chronic pancreatitis
- Pancreatic cancer
2. Bile salt deficiency
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+ve Bile acid breath test
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- Cholestasis (biliary cirrhosis)
- Bacterial overgrowth (deconjugation of bile salts)
- Ilial disease or surgery (decreased reabsorption)
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3. Mixed defects
- Postgastrectomy syndrome
- Zollinger Ellison syndrome
4. Selective defects
e.g. B12 deficiency due to lack of intrinsic factor, drugs impairing
certain nutrients.
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