Chronic Fatty Diarrhea

Aka: Chronic Fatty Diarrhea, Diarrhea due to Malabsorption, Malabsorptive Diarrhea

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