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Steatorrhea is the medical term for fat in stool. Fat in the stool can cause bulky stool that floats, has an oily or greasy appearance, and smells foul. Fat in the stool is fat that the digestive tract was unable to absorb. Temporary steatorrhea may result from dietary changes or intestinal infections. Steatorrhea that is persistent may result from diseases of the biliary tract, pancreas, or intestines.

Fat absorption is dependent upon bile (which is produced in the liver and stored in the gallbladder), pancreatic lipases (enzymes that break down fat), and normal intestine function. Absence of bile is often due to blockage of the biliary tract and can result in pale colored fatty stool and jaundice. Absence of pancreatic lipases is uncommon, but can occur as a result of a diseased pancreas, cystic fibrosis, or an abnormality that is present at birth.

Inflammation of the lining of the intestines, which may occur with conditions such as ulcerative colitis (inflammation of the colon and rectum), Crohn’s disease (inflammation of the bowels), and celiac disease (a severe sensitivity to gluten in the diet), can interfere with absorption of fats. Also, fat absorption may be affected by surgical removal of a portion of the intestines.

Steatorrhea may accompany other symptoms affecting the digestive tract including:
• Abdominal pain or cramping
• Abdominal swelling, distension or bloating
• Abnormally foul-smelling stools
• Bloody stool (the blood may be red, black or tarry in texture)
• Diarrhea
• Gas
• Nausea with or without vomiting
• Pale feces

The dietary therapy of steatorrhea requires knowledge of the cause of the disease associated with the steatorrhea. Once the cause is established, then an approach to the dietary management can be adopted. Recommendations for either the treatment of the primary disease, limitation of fat intake, nutritional support, or pancreatic-enzyme replacement are made depending on the disease process.

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