Steatorrhea

Classification according to ICD-10
K90.0	Idiopathic steatorrhea
K90.1	Tropical steatorrhea
K90.3	Pancreatogenic steatorrhea
K90.4	chronic steatorrhea
ICD-10 online (WHO version 2019)

As steatorrhea (also steatorrhea, Stearrhö) or pancreatic chair or fatty stool is a pathological increase in the fat content in the chair , respectively. It is the result of a fat digestion disorder ( malassimilation ).

Steatorrhea is characterized by a voluminous, clay-colored, foamy stool with a penetrating odor. Common accompanying symptoms are gas , bloating , a tendency to diarrhea and abdominal pain.

There are two basic forms of fat digestion disorder that lead to fatty stool:

• Maldigestion: disruption of the splitting of molecules
• Malabsorption: disturbance of the absorption and / or the removal of the decomposition products

In the case of steatorrhea, the lipases in the small intestine do not adequately break down dietary fats or / and only poorly absorb them . One speaks of steatorrhea when in adults with a normal fat intake of 60–80 g per day, the total fat excretion in the 24-hour stool exceeds 7 g.

Occurrence and treatment

• In celiac disease : The damage to the intestinal tissue leads to considerable impairment of digestion. Dietary fats are also no longer adequately absorbed and remain undigested in the digestive tract. At the moment, the only reliable way to treat the disease and thereby minimize symptoms such as steatorrhea is a lifelong gluten-free diet, which allows the intestinal mucosa to recover and the risks of long-term consequences are reduced.

• For exocrine pancreatic insufficiency : The missing enzymes in the pancreatic secretion can be replaced in the form of pancreatin and / or rizoenzymes for consumption with meals. The lipases supplied in this way break down dietary fats , which improves absorption and reduces fat excretion.

• In Crohn's disease : Basically, a distinction is made in therapy between relapse therapy and maintenance of remission. The aim of relapse therapy is to alleviate the acute symptoms when the symptoms worsen, i.e. when there is a relapse. With remission-maintaining therapy, the number of relapses should be reduced, i.e. the time of remission should be extended. The conservative (medication) and operative therapeutic approaches complement each other. If fatty stools occur, the usual dietary fat should be partially replaced by easily digestible medium-chain triglycerides (MCT fats). In addition, low-fat foods and preparation methods should be used.

• With pancreatitis : With chronic pancreatitis, the patient must refrain from alcohol for life. In addition, with existing pancreatic insufficiency in the context of chronic pancreatitis, the missing digestive enzymes, in particular lipase, are taken in the form of pancreatin and / or rizoenzymes with meals. However, enzyme administration is not indicated in the acute episode of chronic pancreatitis or in acute pancreatitis.

• For pancreatic cancer : The treatment of pancreatic cancer usually involves surgical removal of the tumors. Further surgical interventions may also be planned to alleviate symptoms (e.g. a stent in the bile ducts to ensure patency). The treatment of symptoms such as steatorrhea - as in other diseases of the pancreas - is medically based on enzyme replacement therapy using rizoenzymes and / or pancreatin.

• In the case of obstruction of the bile duct by a gallstone (choledocholithiasis): If gallstones cause fatty stools and other health complaints, the cause must be treated (i.e. stones must be removed), because without sufficient bile fluid, fat digestion disorders and a correspondingly high fat content occur Chair. Gallstones can be removed, for example, with medication with the help of so-called ursodeoxycholic acid or chenodeoxycholic acid by dissolving them, or mechanically with the help of extracorporeal shock wave lithotripsy. The stones are smashed with shock waves.

• For cholangitis : Inflammation of the biliary tract is usually caused by bacteria or gallstones and is associated with fever, yellowing of the skin, upper abdominal pain and digestive problems such as fatty stools. The treatment takes place - depending on the cause - with antibiotics or a gallstone removal. If the cholangitis heals and gallstones are removed, the prognosis is very good.

• In malassimilation due to bacterial overgrowth of the small intestine . Here, too, the therapy of fatty stool depends on the underlying disease (e.g. chronic inflammatory bowel disease, celiac disease, cystic fibrosis or exocrine pancreatic insufficiency). The bacterial overgrowth prevents the small intestine from functioning as an organ for absorbing nutrients (e.g. fats, vitamins and minerals). In addition, there is a deconjugation of bile acids, which disrupts fat absorption. In the case of bacterial overgrowth, intestinal rehabilitation through locally limited antibiotic treatment, the elimination of the causes (e.g. motility disorders), supplementation of the inadequately absorbed nutrients and enzyme replacement therapy for underlying functional disorders of the pancreas has proven its worth.

• After the surgical removal of a part of the small intestine ( short bowel syndrome ): When parts of the small intestine are removed, various complications arise because the different sections have different tasks in digesting and absorbing nutrients. Fat stools occur, among other things, because too little fat is absorbed in the remaining intestine. Patients with short bowel syndrome receive nutritional therapy tailored to their clinical picture in order to avoid pronounced malnutrition. A high-carbohydrate diet is recommended for massive fat stools. The proportion of medium-chain fatty acids (MCT) in the triglycerides should be increased to 50 to 75 percent.

• As a side effect of weight loss drugs ( orlistat ) or certain antibiotics , e.g. B. Doxycycline . While steatorrhea, a side effect of antibiotic therapy, can only be reduced to a certain extent by taking the drug after or with meals, with orlistat the extent of fatty stool can be partially regulated by the amount of fat consumed. Orlistat inhibits the body's own pancreatic lipase and thus ensures that part of the fat is excreted undigested. If the amount of fat ingested from food is not reduced when Orlistat is used at the same time, massive fat stools will result, which can only be improved as part of the therapy if the fat absorption is restricted.

literature

• Jürgen Hotz: Key symptom fat stool. In: Deutsches Ärzteblatt , Edition A, Volume 81, Issue 42 of October 17, 1984 (49)
• Hartmut Köppen: Gastroenterology for Practice . Georg Thieme, 2010, ISBN 978-3-13-146761-4 , p. 153-166 ( online ).

Individual evidence

1. ↑ ^{a b c} Alphabetical directory for the ICD-10-WHO Version 2019, Volume 3. German Institute for Medical Documentation and Information (DIMDI), Cologne, 2019, p. 823.
2. ↑ Elisabeth Nolde: Abdominal cramps, fatty stools and diarrhea due to SIBO syndrome. In: Medical Tribune , August 4, 2014.

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !