II. Definitions
- Chronic Fatty Diarrhea (Malabsorptive Diarrhea)
- Increased stool volume with increased fecal fat contents (due to malabsorption)
III. Causes: Malabsorption or altered Digestion
- Drug-Induced Diarrhea
- Amyloidosis
- Carbohydrate malabsorption (e.g. Lactose Intolerance), which also causes Osmotic Diarrhea
- Gluten Sensitive Enteropathy (Celiac Sprue)
- Gastric Bypass
- Short bowel syndrome
- Superior Mesenteric Artery insufficiency or Chronic Mesenteric Ischemia
- Biliary tract or Pancreas insufficiency
- Pancreatic insufficiency
- Bile acid inadequate in bowel
- Lymphatic injury (e.g. Congestive Heart Failure, Lymphoma)
- Non-invasive Small Bowel infection
- Giardia
- Small BowelBacterial overgrowth (>100,000 Bacteria/ml)
- Tropical sprue
- Tropheryma whipplei (Whipple Disease)
- Tropheryma whipplei infection of the Small Bowel (or endocardium or CNS)
IV. Symptoms
- Pale, bulky stools
- Frothy or greasy stools
- Foul odor to stool
- Weight loss with nutritional deficiency
- Resolves within 1-2 days of not eating
- Excessive Flatus
V. Evaluation
- Evaluate for anatomic abnormality
- Consider CT Abdomen
- Consider Colonoscopy with biopsy
- Evaluate for pancreatic insufficiency
- Obtain stool chymotrypsin level
- Confirm a positive chymotrypsin level with a Secretin test
VI. References
- Schiller in Feldman (2002) Sleisenger GI, p. 136
- Burgers (2020) Am Fam Physician 101(8): 472-80 [PubMed]