Diminished Micellar Phase Lipid in Patients with Chronic Nonalcoholic Liver Disease and Steatorrhea

Abstract

Steatorrhea is a common feature of chronic liver disease. The mechanism of this abnormality was studied in 15 nonalcoholic subjects (3 normal control subjects and 12 patients with chronic liver disease, 9 of whom had steatorrhea). Intestinal contents were obtained after the subjects had ingested a standard fat-containing meal; bile salt, total lipid, fatty acid, and pigment concentrations were measured in both total and micellar phases. The results obtained in normal subjects and control patients without steatorrhea were similar. The fatty acid to total lipid ratio was the same in both the steatorrhea and control groups. In patients with steatorrhea, significantly less lipid was incorporated into the micellar phase and intraluminal bile salt concentrations were subnormal. These results indicate that, in patients with chronic liver disease, steatorrhea is associated with subnormal intraluminal concentrations of conjugated bile salts and impaired micellar lipid incorporation. It is suggested that steatorrhea in nonalcoholic patients is unlikely to be a result of pancreatic exocrine deficiency but more likely is due to the inability of subnormal concentrations of bile salts to fulfill their normal role in fat absorption.