II. Causes: Malabsorption or altered digestion

  1. Drug-Induced Diarrhea
  2. Amyloidosis
  3. Carbohydrate malabsorption (e.g. lactose intollerance)
  4. Gluten Sensitive Enteropathy (Celiac Sprue)
  5. Gastric Bypass
  6. Whipple's Disease (Tropheryma whipplei infection)
  7. Short bowel syndrome
  8. Superior Mesenteric Artery insufficiency
  9. Pancreatic insufficiency
  10. Bile acid inadequate in bowel
  11. Mesenteric Ischemia
  12. Non-invasive Small Bowel infection
    1. Giardia
    2. Small Bowel bacterial overgrowth (>100,000 bacteria/ml)
    3. Tropical sprue

III. 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

IV. 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

V. References

  1. Schiller in Feldman (2002) Sleisenger GI, p. 136

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