Steatorrhea

What Is Steatorrhea?

[dropcap]S[/dropcap]teatorrhea is a condition of abnormal stool composition and consistency that is due to high fat content because fat from food is not  digested and absorbed into the body but rather passes out with stool.¹

Q: How does fatty stool look?

A: The stool in steatorrhea appears pale, bulky and may float in the toilet. If stool is loose, it varies from a pudding consistency to whipped cream. If it is solid, it can vary from thin sqiggles to big turds that smear the sides of the toilet bowl. All types have a foul smell.

Fat of any kind must be digested, or broken down, by enzymes into fatty acids and glycerol and then these parts only are absorbed through the small intestinal lining into the body. The failure to digest or absorb fats deprives the body of these foodstuffs needed for many functions such as blood clotting and vital cell parts such as eye and brain structure.

Fat malabsorption produces malabsorption of vitamins A, D, E, and K because these vitamins can only be absorbed along with fatty acids.

What Is Steatorrhea In Celiac Disease and/or Gluten Sensitivity?

• Relationship between steatorrhea and celiac disease. Steatorrhea is a classic sign and classic presentation of fat malabsorption in untreated celiac disease.¹
• Relationship between steatorrhea and fatty acids. Most patients with celiac disease were found to have low essential fatty acids in their blood because of poor fat digestion and absorption, the most significant being arachidonic acid. An inadequate supply of arachidonic acid in the body disrupts the production of prostaglandins, prostacyclin, with a tendency to thrombosis (blood clots).²

How Prevalent is Steatorrhea In Celiac Disease and/or Gluten Sensitivity?

Steatorrhea is common in patients with untreated celiac disease, occurring in one fifth of patients with diarrhea.³

A consecutive series of 106 patients with adult celiac disease found a prevalence of steatorrhea in 4% of patients.⁴

What Are The Symptoms Of Steatorrhea In Celiac Disease and/or Gluten Sensitivity?

• Steatorrhea in celiac disease is marked by bulky, pale, foul-smelling stool that stick to the toilet bowl and are hard to flush.⁵

How Does Steatorrhea Develop In Celiac Disease and/or Gluten Sensitivity?

Steatorrhea in celiac disease results from malabsorption of fat in the small intestine.

Does Steatorrhea Respond To Gluten Free Diet?

Yes. There is rapid and substantial improvement of celiac disease-related steatorrhea with gluten free diet.³

What Do Medical Research Studies Tell About Steatorrhea In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Adult celiac disease in Ireland: a case series.” This retrospective study investigating files from a patient database to analyse the presenting symptoms, associated conditions and complications in a consecutive series of patients with adult celiac disease found a prevalence of steatorrhea in 4 (4%) of patients.

One hundred and six patients (69 females to 37 males, mean age: 46, range: 23-95 years) were included. The modes of presentation were diarrhea in 44 patients (45%), weight loss in 41 (42%), anemia in 37 (38%), abdominal pain in 15 (15%), fatigue in 8 (8%), hypocalcaemia in 4 (4%) and steatorrhoea in 4 (4%). Associated conditions included thyroid disorders in 7 patients (7%), bipolar affective disorder in 4 (4%), major depression in 3 (3%), rheumatoid disease in 3 (3%), inflammatory bowel disease in 4 (4%) and type I diabetes mellitus in 2 (2%). Malignancy emerged as a major complication in 15 patients (15%).⁴

“Deficit of polyunsaturated fatty acids in patients with celiac disease.” This study investigating fatty acid composition of lipids in blood serum of patients with celiac disease, their role in metabolic processes and methods of therapy found a substantial steatorrhea in patients with celiac disease with malabsorption syndrome III in severity.

Most patients with celiac disease were found to decrease the essential fatty acids, the most significant–arachidonic acid, which leads to disruption of the synthesis of prostaglandins, prostacyclin, and a tendency to thrombosis.⁶

Sources:

1. Murray JA, The widening spectrum of celiac disease. American Journal of Clinical Nutrition. Mar 1999;69 (3):354-365. [↩] [↩]
2. Krums LM. Deficit of polyunsaturated fatty acids in patients with celiac disease. Eksp Klin Gastroenterol. 2011;(3):31-4. [↩]
3. Murray JA, Watson T, Clearman B, Mitros F. Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease. American Journal of Clinical Nutrition. Apr 2004;79(4):669-73. [↩] [↩]
4. Saleem A, Connor HJ, Regan PO. Adult coeliac disease in Ireland: a case series. Ir J Med Sci. 2012 Jun;181(2):225-9. doi: 10.1007/s11845-011-0788-z. [↩] [↩]
5. Heidinger K, Kemkes-Matthes B, Matthes KJ, Franke F, Voss R, Heckers H. Endemic sprue: its first diagnosis based on bleeding complications. Deutsche Medizinische Wochenschrift. Nov 10, 1995;120(45):1543-6. [↩]
6. Krums LM. Deficit of polyunsaturated fatty acids in patients with celiac disease. Eksp Klin Gastroenterol. 2011;(3):31-4. [↩]