Every day, your pancreas produces around 8 ounces of digestive enzymes to help break down dietary fats. However, when the pancreas is damaged, it can no longer make these enzymes, and the body loses its ability to digest fats and absorb enzymes. Since the body cannot use undigested fats, they have to be removed through the stool (poop), a medical condition known as steatorrhea. In this blog post, we’ll explore the topic of steatorrhea in-depth, featuring expert insights from Dr. C. Mel Wilcox, a leading specialist in pancreatic diseases.
What is Pancreatitis?
Pancreatitis is the inflammation of the pancreas, an organ located behind the stomach. When digestive enzymes become active while still in the pancreas, they can cause damage to the pancreatic tissue and nearby organs. Symptoms may include severe abdominal pain, nausea, vomiting, fever, and elevated heart rate.Â
- Acute Pancreatitis. Acute pancreatitis refers to a one-time occurrence of inflammation in the pancreas. It is often sudden and extremely painful.
- Recurrent Acute Pancreatitis. Recurrent acute pancreatitis (RAP) involves multiple episodes of acute inflammation, with complete recovery between episodes. Patients with RAP are at a higher risk of developing chronic pancreatitis.
- Chronic Pancreatitis. Chronic pancreatitis is a long-term inflammation of the pancreas that can result in permanent damage and scarring. Over time, this can impair the pancreas’ ability to function properly, causing digestive problems and other complications such as diabetes, fat malabsorption (steatorrhea), and bone disease.
What is Steatorrhea?
If you have a damaged pancreas and cannot make enough digestive enzymes to break down fat properly, you will experience steatorrhea. Since the body cannot process undigested fats, they must be removed through the stool. Steatorrhea indicates that your digestive system is not working correctly. This is most commonly due to issues with the pancreas. If you have steatorrhea, you may notice that your stool is:
Pale
Foul-smelling
Greasy
Sticky and hard to flush
Loose or runny stool that is bulkier than usual
Steatorrhea vs. Diarrhea
Steatorrhea and diarrhea are both common symptoms among patients with pancreatitis. However, they mean different things and are treated differently. Diarrhea can result from pancreatic inflammation and dysfunction, or a variety of other conditions such as small bowel disease (i.e. celiac disease), colonic problems, including infections, or inflammation of the colon (colitis). Symptoms typically clear up within a few days without intervention for many causes. While diarrhea is common among all people, persistent symptoms with the addition of a fever may require medical attention.Â
Common symptoms of diarrhea include:
- Watery stool
- BloatingÂ
- Stomach cramps
- More frequent bowel movementsÂ
Risks of Steatorrhea
Long-term steatorrhea, where the body struggles to digest fats, can lead to additional complications such as malabsorption and nutritional deficiencies. It’s important to address and manage the symptoms of steatorrhea to maintain and improve your health and well-being.Â
MalabsorptionÂ
Malabsorption is a condition where the intestines cannot absorb essential nutrients from food and drinks. Fat malabsorption is particularly relevant to steatorrhea because it prevents the absorption of fats and fat-soluble vitamins (A, D, E, and K). Unabsorbed fats move from the small intestine to the colon causing fatty stools. Initial symptoms will include abdominal pain, bloating, and nausea as noted above.Â
Suppose you have malabsorption for an extended period. Depending upon the severity, your body will show signs of deficiencies in the nutrients you cannot absorb. You may experience the following:
- Unintentional weight loss
- Bruising easily
- Dry skin & skin lesions
- Dry hair & hair loss
- DehydrationÂ
- Anemia (weakness, lightheadedness)
Nutritional Deficiencies
Nutritional deficiencies occur when the body lacks the nutrients necessary to keep the body healthy. Since most essential nutrients come from our diet, it is important to maintain a well-balanced diet. In the case of steatorrhea, where fat malabsorption is the main issue, a deficiency in these essential nutrients, as well as vitamins and minerals, can negatively impact your health. For example, calcium and vitamin D are crucial for bone health. If these two are deficient, it can lead to bone disease. Similarly, magnesium deficiency can result in muscle weakness, cramps, and cardiac arrhythmias.
Steatorrhea in Pancreatitis Patients
The breakdown and absorption of fats usually occur in the small intestine, where digestive enzymes from the pancreas are needed. In patients with exocrine pancreatic insufficiency (EPI), the pancreas cannot produce enough digestive enzymes, so the body must remove fats through the stool.
Exploring Exocrine Pancreatic Insufficiency (EPI)
Once food enters the stomach, the pancreas releases digestive enzymes into small pancreatic ducts. The pancreatic juice then reaches the small intestine through the main pancreatic duct, where enzymes mix with bile to break down food. In EPI, however, the pancreas is not releasing enough enzymes, so nutrients such as fat are not broken down. Steatorrhea is a common development in EPI patients. This leads to complications such as malnutrition, vitamin deficiencies, and other digestive issues. EPI usually develops slowly over the years. About 60% to 90% of chronic pancreatitis patients develop EPI within 10 to 12 years of diagnosis.
Patients with EPI often need to alter their diets to manage pancreatic symptoms and prevent further complications. Patients should not significantly reduce their fat intake, since fats are important for maintaining weight and providing essential nutrients. Instead, using pancreatic enzyme supplements is important to help manage fat digestion without needing to drastically cut fats from your diet (see below).
Diagnosing Exocrine Pancreatic Insufficiency
The fecal elastase test is currently the most common and accurate way to diagnose EPI. Elastase is a digestive enzyme made by the pancreas to break down carbohydrates, fats, and proteins in food. If your pancreas works properly, you will have elastase in your stool. Depending on the severity of pancreatic disease, the fecal elastase may be normal, minimally decreased, or significantly reduced. This test does have limitations and is not perfect. Another diagnostic test is the 72-hour stool fat test, where stool samples are collected over three days to determine the amount of fat digested and absorbed by the body. This is not commonly done today.
If you are experiencing steatorrhea, it is recommended that you talk to your doctor about the possibility of exocrine pancreatic insufficiency, as these symptoms may be associated with the condition.
Managing Symptoms and Supporting Health
Though there is currently no cure for EPI, it is treatable. Its symptoms can be managed with pancreatic enzyme replacement therapy (PERT) and dietary changes.
Pancreatic Enzyme Replacement Therapy
Pancreatic enzyme replacement therapy involves taking medication to replace the enzymes naturally made by the pancreas to digest food. This medication typically comes in capsules or tablets containing a blend of enzymes. Though less effective than natural enzymes, PERT can improve carbohydrate, fat, and protein absorption. It effectively reduces the symptoms associated with EPI, such as malabsorption, nutritional deficiency, and abdominal pain.
PERT should be taken alongside the first bite of meals, snacks, or milk-based drinks for full effect. It may be necessary to adjust the dosage for larger meals or those with high amounts of fat. Distributing enzyme intake evenly throughout the meal is also recommended, especially if eating takes longer than 20 minutes.
Dietary Changes
Food provides us with essential nutrients that cannot be replaced through artificial supplements such as tablets. So, to treat malabsorption and nutritional deficiencies, your provider may recommend dietary changes instead.
Chronic pancreatitis patients are generally recommended a low-fat, high-protein diet with plenty of fruits and vegetables. However as noted above, fat intake should not be significantly reduced but rather the dose of enzymes increased with more fat intake. It is important to discuss your diet plan with your doctor to determine what is best for you.
Key Takeaways
- Steatorrhea results from impaired fat digestion
- Long-term steatorrhea can lead to malabsorption and nutritional deficiencies
- Patients with exocrine pancreatic insufficiency (EPI) experience a lack of pancreatic enzyme production, affecting digestion and fat absorption.
- Steatorrhea is a common symptom of EPI and should be discussed with your medical provider.
- Pancreatic enzyme replacement therapy (PERT) treats exocrine pancreatic insufficiency (EPI) by replacing the enzymes normally made by the pancreas to help digestion.
- Dietary changes are another option for managing symptoms
Stay Up-To-Date on the Latest Pancreatitis Advancements
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