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the presence of greater than normal amounts of fat in the feces which are frothy and foul smelling and floating; a symptom of disorders of fat metabolism and malabsorption syndrome

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/09/21 20:14:53」(JST)

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Steatorrhea (or steatorrhoea) is the presence of excess fat in feces. Stools may also float due to excess lipid, have an oily appearance and be especially foul-smelling.^{[citation needed]} 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. The definition of how much fecal fat constitutes steatorrhea has not been standardized.

Causes[edit source | edit]

Possible biological causes can be lack of bile acids (due to liver damage, hypolipidemic drugs, gallbladder removal (cholecystectomy), defects in pancreatic enzymes, and defective mucosal cells. The absence of bile acids will cause the feces to turn gray or pale. Another cause of steatorrhea is due to the adverse effect of octreotide or lanreotide, which are analogs of somatostatin, used clinically to treat acromegaly.

Associated diseases[edit source | edit]

Malabsorption, e.g. in inflammatory bowel disease, celiac disease, and abetalipoproteinemia^[1]^[2]
Exocrine pancreatic insufficiency
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
Celiac Disease
Zollinger-Ellison syndrome
Giardiasis (a protozoan parasite infection)
Graves' disease / hyperthyroidism
Abuse or misuse of certain prescribed slimming pills (such as Orlistat)
Tropical sprue

In patients with steatorrhea, other associated symptoms may include reduced bone density, difficulty with vision under low light levels, and slow blood clotting times.

Weight-loss drugs[edit source | edit]

Steatorrhea can also be due to eating indigestible oils or fats, such as Olestra, or as a side effect of medicines that prevent the absorption of dietary fats, such as Orlistat.^[3]^[4]^[5]^[6]

Artificial fats[edit source | edit]

The fat substitute Olestra, used to reduce digestible fat in some foods, was reported to cause leakage in some consumers during the test-marketing phase. As a result, the product was reformulated before general release to a hydrogenated form that is not liquid at physiologic temperature. The U.S. Food and Drug Administration warning indicated excessive consumption of Olestra could result in "loose stools"; however, this warning has not been required since 2003.^[4]^[6]

Medications[edit source | edit]

Orlistat (also known by trade names Xenical and Alli) is a diet pill that works by blocking the enzymes that digest fat. As a result, some fat cannot be absorbed from the gut and is excreted in the feces instead of being metabolically digested, sometimes causing oily anal leakage. VYTORIN® (ezetimibe/simvastatin) Tablets can cause Steatorrhea in some people. ^[3]^[5]

Natural fats[edit source | edit]

Consuming jojoba oil has been documented to cause steatorrhea and anal leakage because it is indigestible.^[7]

Consuming escolar and oilfish (sometimes called butterfish) will often cause steatorrhea, also referred to as Gempylotoxism or Gempylid Fish Poisoning or keriorrhea.^[8] The fish is commonly used in party catering due to its delicate flavor and because it is cheap and readily available.^{[citation needed]}

Paleo diets[edit source | edit]

Following a Paleo diet can cause steatorrhea, especially towards the start of the diet.

Treatment[edit source | edit]

Treatments are mainly correction of the underlying cause, as well as digestive enzyme supplements.^[9]

References[edit source | edit]

^ Moutzouri, E; Elisaf, M; Liberopoulos, EN (2011 Mar). "Hypocholesterolemia.". Current vascular pharmacology 9 (2): 200–12. doi:10.2174/157016111794519354. PMID 20626336.
^ Hasosah, MY; Shesha, SJ; Sukkar, GA; Bassuni, WY (2010). "Rickets and dysmorphic findings in a child with abetalipoproteinemia". Saudi medical journal 31 (10): 1169–71. PMID 20953537.
^ ^a ^b Squires, Sally (2006-01-24). "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."
^ ^a ^b "Frito-Lay Study: Olestra Causes "Anal Oil Leakage"". Center for Science in the Public Interest. 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.""
^ ^a ^b "The Word Is 'Leakage'. Accidents may happen with a new OTC diet drug.". Newsweek. June 25, 2007. Archived from the original on 2007-06-18. 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."
^ ^a ^b "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
^ Bad Bug Book - Foodborne Pathogenic Microorganisms and Natural Toxins Handbook: Gempylotoxin, FDA
^ WrongDiagnosis >Treatments for Steatorrhea Retrieved on 20 Mars, 2009^{[dead link]}

UpToDate Contents

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1. 吸収不良の臨床的特徴および診断 clinical features and diagnosis of malabsorption
2. 吸収不良の治療の概要 overview of the treatment of malabsorption
3. 栄養の吸収および吸収不良の機序 mechanisms of nutrient absorption and malabsorption
4. Approach to the adult with chronic diarrhea in resource-rich settings
5. Overview of the causes of chronic diarrhea in children in resource-rich countries

English Journal

Isolated Roux loop pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy: a prospective randomized study.

El Nakeeb A1, Hamdy E, Sultan AM, Salah T, Askr W, Ezzat H, Said M, Zeied MA, Abdallah T.
HPB : the official journal of the International Hepato Pancreato Biliary Association.HPB (Oxford).2014 Aug;16(8):713-22. doi: 10.1111/hpb.12210. Epub 2014 Jan 28.
OBJECTIVES: The optimal strategy for the reconstruction of the pancreas following pancreaticoduodenectomy (PD) is still debated. The aim of this study was to compare the outcomes of isolated Roux loop pancreaticojejunostomy (IRPJ) with those of pancreaticogastrostomy (PG) after PD.METHODS: Consecuti
PMID 24467711

Follow-up of patients with pseudotumoral chronic pancreatitis: Outcome and surveillance.

Téllez-Ávila FI, Villalobos-Garita A, Giovannini M, Chan C, Hernández-Calleros J, Uscanga L, Ramírez-Luna MÁ.
World journal of gastroenterology : WJG.World J Gastroenterol.2014 Jul 14;20(26):8612-6. doi: 10.3748/wjg.v20.i26.8612.
AIM: To follow up patients with pseudotumoral chronic pancreatitis (PCP) to assess their outcome and identify an optimal surveillance interval.METHODS: Data obtained prospectively were analyzed in a retrospective manner. Patients with clinical evidence of chronic pancreatitis (abdominal pain in the
PMID 25024616

Altered FXR signaling is associated with bile acid dysmetabolism in short bowel syndrome-associated liver disease.

Pereira-Fantini PM1, Lapthorne S2, Joyce SA3, Dellios NL2, Wilson G4, Fouhy F5, Thomas SL2, Scurr M2, Hill C3, Gahan CG3, Cotter PD6, Fuller PJ7, Hardikar W8, Bines JE9.
Journal of hepatology.J Hepatol.2014 Jul 3. pii: S0168-8278(14)00455-3. doi: 10.1016/j.jhep.2014.06.025. [Epub ahead of print]
BACKGROUND AND AIMS: Despite the mortality associated with liver disease observed in patients with short bowel syndrome (SBS), mechanisms underlying the development of SBS-associated liver disease (SBS-ALD) are poorly understood. This study examines the impact of bacterially-mediated bile acid (BA)
PMID 24999016

Japanese Journal

膵機能不全患者に対する消化酵素大量補充療法の長期効果の検討

今昭人,柳町幸,丹藤雄介,三上恵理,松本敦史,佐藤江里,田中光,須田俊宏,中村光男
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NAID 10025582130

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中村光男,丹藤雄介,柳町幸,田中光,志津野江里,野木正之
膵臓 = The Journal of Japan Pancreas Society 22(4), 454-461, 2007-08-25
NAID 10024366481

Celiac disease with Takayasu arteritis

ARSLAN NUR,BUYUKGEBIZ BENAL,OZTURK YESIM
Pediatrics international : official journal of the Japan Pediatric Society 47(6), 708-710, 2005-12-01
NAID 10017024778