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Steatorrhea
Published in Charles Theisler, Adjuvant Medical Care, 2023
Steatorrhea is the presence of excess fat in the feces with symptoms of foul-smelling, foamy, frothy, or mucous-filled stools, bloating, and diarrhea. Steatorrhea can happen simply from eating a meal high in fat and fiber or potassium oxalate.1 Severe or long-term symptoms of steatorrhea may be a sign of a medical condition, such as a malab-sorption disorder, enzyme deficiency, or gastrointestinal disease.2 Since steatorrhea is caused by decreased absorption of fat by the intestine, there are also typically significant losses of calcium, magnesium, and fat-soluble vitamins. Many different medical conditions can cause steatorrhea. For that reason, the best treatment is contingent upon the underlying diagnosed condition causing the fatty stools.
Methods for the Analysis of Gastrointestinal Function
Published in Shayne C. Gad, Toxicology of the Gastrointestinal Tract, 2018
Fat malabsorption can be measured from fat in fecal samples [23,40,41]. Stool samples are pooled, mixed with water and homogenized. A sample may then be analyzed by hydrolysis, extraction, and titration of the fatty acids. Steatorrhea is a condition where more fat in the stool is present than normal, an indication of decreased fat absorption. A coagulation test for the determination of prothrombin time is an indication of Vitamin K absorption [39]. An increase in prothrombin time may also be due to steatorrhea. Fat malabsorption has also been determined in breath tests to detect 14CO2 levels after ingestion of meals containing 14C labeled fats or triglycerides [42–44] or in nonradioactive breath tests [45].
The pancreas
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Steatorrhoea is treated with enzyme supplementation. Diabetes mellitus, if it develops, is treated with oral hypogly- caemics or insulin as appropriate, and pain with either analgesics or an appropriate nerve block.
Nordic guidelines 2021 for diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasms
Published in Acta Oncologica, 2021
Eva Tiensuu Janson, Ulrich Knigge, Gitte Dam, Birgitte Federspiel, Henning Grønbaek, Peter Stålberg, Seppo W. Langer, Andreas Kjaer, Johanna Arola, Camilla Schalin-Jäntti, Anders Sundin, Staffan Welin, Espen Thiis-Evensen, Halfdan Sorbye
More than 90% of NETs express SSTRs. The SSAs octreotide and lanreotide are used for symptomatic and anti-proliferative treatment. Similar symptomatic and biochemical response is observed in NET patients using either one of the SSAs. SSA may have an effect even if the uptake on SRI is low. The anti-proliferative effect of SSA treatment in NET-patients has been demonstrated in randomised trials [27,28]. In the PROMID study including SI-NET patients, median PFS was significantly longer using octreotide LAR compared to placebo (14.3 vs. 6 months). In the CLARINET study including non-functioning NETs of different origins, median PFS was significantly longer using lanreotide autogel compared to placebo (38.5 vs 18 months). SSA treatment is therefore recommended in metastatic GEP-NET disease with a low Ki-67 (<10%). The dose may be increased or the interval between injections shortened to achieve symptomatic or disease control. In the NETTER-1 study, SI-NET patients progressing on standard SSA dose were randomised to PRRT or SSA dose escalation. Although PRRT was superior, the higher dose of SSA resulted in a further 9 months stabilisation of disease [29]. Common side effects of SSAs include abdominal pain, diarrhoea, flatulence, nausea, subcutaneous nodules at the injection site and development of bile stones. Steatorrhoea caused by reduced pancreatic enzyme secretion should be treated with pancreatic enzyme replacement.
Exocrine pancreatic insufficiency is common in people living with HIV on effective antiretroviral therapy
Published in Infectious Diseases, 2018
Pancreas is the only gland in the human body with both exocrine and endocrine functions. Dysfunction of the endocrine part results in diabetes and exocrine dysfunction results in pancreatic insufficiency [1]. Exocrine pancreatic insufficiency (EPI) results from a progressive loss of acinar pancreatic cells, which leads to secretion of an insufficient quantity of digestive enzymes into the duodenum. Maldigestion results when exocrine pancreatic function is reduced by more than 90% [2]. Symptoms of EPI include steatorrhoea, diarrhoea, flatulence, bloating and abdominal discomfort [3]. The most common cause of EPI is chronic pancreatitis, but EPI can also be caused by several other conditions, such as diabetes, celiac disease, inflammatory bowel diseases, cystic fibrosis, partial or total surgical resection of pancreas, loss of function of pancreatic tissue or obstruction of the main pancreatic duct and gastrectomy [4]. EPI has also been associated with HIV and it has been proposed as an underdiagnosed and important cause of diarrhoea and fat malabsorption in adults and children living with HIV [5–7].
Importance of Pancreatic Enzyme Replacement Therapy after Surgery of Cancer of the Esophagus or the Esophagogastric Junction
Published in Nutrition and Cancer, 2018
Thomas Kiefer, Dorothea Krahl, Kathrin Osthoff, Peter Thuss-Patience, Jörg Bunse, Ulrich Adam, Marc H. Jansen, Rudolf Ott, Robert Pfitzmann, Matthias Pross, Thomas Kohlmann, Georg Daeschlein, Hermann Buhlert, Heinz Völler, Carsten Hirt
Steatorrhea is a sign of exocrine pancreatic insufficiency and is amongst others already described following pancreatic or gastric surgery. In patients after total gastrectomy a reduction of pancreatic juice volume, trypsin, chymotrypsin, amylase and bicarbonate secretion after stimulation has been observed (8). In a study by Bragelmann et al. (9). PERT improved fecal frequency and fecal consistency in patients with steatorrhea after gastrectomy for gastric cancer, however no difference was seen regarding body mass index. To our knowledge, Huddy et al. reported 2013 steatorrhea in patients after esophageal resection for the first time. Improvement of symptoms of exocrine pancreatic insufficiency by PERT depended upon fecal elastase-1 levels. An increase in body weight was observed in 7/10 (70%) patients with elastase-1 levels below 200 µg/g but only in 2/12 (17%) patients with fecal elastase-1 levels in the range of 200–500 µg/g (6).