Steatorrhea

Overview
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,

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.

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.

Natural fats
Consuming Jojoba oil has been documented to cause steatorrhea and anal leakage because it is indigestible.

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.