Detection Of Steatorrhea Research Articles

Fecal elastase-1 is useful in the detection of steatorrhea in patients with pancreatic diseases but not after pancreatic resection

BackgroundFecal elastase-1(FE-1) has been suggested as an alternative to steatorrhea quantification to evaluate pancreatic insufficiency, but its diagnostic performance has not been compared with steatorrhea in chronic pancreatitis or after pancreatic resection. MethodsThe relationship between steatorrhea and FE-1 was studied in patients with chronic pancreatic disorders or pancreatic resection. Student's t test and ANOVA were used for statistical analysis, accepting 0.05 as limit for significance. ResultsEighty-two patients were studied (42 non-operated; 40 previously submitted to pancreatic resection). Fat output was higher in operated than non-operated patients (29.2 ± 3.1 vs 9.9 ± 2.2 g/day, p < 0.001) FE-1 was more severely reduced in operated patients (202 ± 32.3 μg/g in non operated vs 68.6 ± 18.2 in operated patients; p < 0.001). Steatorrhea was significantly more severe in operated patients across different levels of FE-1. The relationship between FE-1 and steatorrhea was described by a power regression model, with a regression line significantly different in operated and non-operated patients (p < 0.001). A steatorrhea of 7 g (upper limit of normal range) was calculated by this regression line when FE-1 is 15 μg/g in non-operated, but as high as 225 μg/g in operated patients. ConclusionFE-1 is useful to identify pancreatic insufficiency. Steatorrhea is anticipated in non-operated patients only when FE-1 is below the limit for a confident measurement of our assay. In operated patients, steatorrhea may be present even if FE-1 is only slightly reduced, that suggests a role for non pancreatic factors. FE1 is not useful to identify operated patients at risk of malabsorption.

Improved Steatocrit Results Obtained by Acidification of Fecal Homogenates Are Due to Improved Fat Extraction

Conflicting results have been reported on the value of the steatocrit as a screening test for steatorrhea. We recently modified the test procedure by fecal acidification with the hope of improving fat extraction and consequently the sensitivity of the test. The aim of the present study was to ascertain whether or not fecal acidification led to improved fat extraction by comparing the fat content of both fatty and solid layers obtained by centrifugation of 12 acidified (acid steatocrit) and unacidified (classical steatocrit) steatorrheal stool samples. The fat content of fatty and solid layers was evaluated using the semiquantitative (+ = 1, +2 = 2, +3 = 3) scoring system described by Drummey for the interpretation of the Sudan microscopic method for fecal fat. The fatty layers sum of scores for the 12 samples examined was 31 and 16 for the acid and classical steatocrit, respectively. The solid layers sum of scores for the 12 samples was 13 and 24 for the acid and classical steatocrit, respectively. Fat extraction from stool samples was significantly improved after fecal sample acidification (p < 0.005). Acid steatocrit results agreed better with chemically measured fecal fat than classical steatocrit results. We conclude that fecal acidification, by improving fat extraction, increases the reliability of the steatocrit method for the detection of steatorrhea.

A RAPID METHOD FOR QUANTITATIVE DETERMINATION OF FECAL FAT BASED ON THE PRINCIPLE OF ELECTRICAL CAPACITANCE.

Abstract A method of fat analysis based on electrical capacitance of a fat solvent-solution has been adapted for analysis of stools. A 75 Gm. aliquot of 3 day stool collection was extracted in a blender with 100 ml. of solvent (a mixture of chlorinated hydrocarbons) and a 15 Gm. filter aid for five minutes. The clear filtrate was placed in a condenser of a radioosoillator (available commercially), and frequency was read directly and converted to fat percentage from a calibration curve. Becovery of triolein added to normal stool pools was approximately 90 per cent. Forty-four determinations performed on 15 stool collections showed the standard error of a single determination to be 0.76 per cent fat. When this method was compared to the chemical method of van de Kamer, a correlation coefficient of 0.89 was obtained. Fecal fat excretion assessed in 9 normal subjects evas 2.8 Gm. per day with a range of 0.2 to 5.4 Gm. per day. Present results indicate that the electrical capacitance method provides a sufficiently rapid and quantitative assessment of total fecal fat excretion as a routine clinical procedure for the detection of steatorrhea.

Reliability of I131-Triolein Test in the Detection of Steatorrhea

Reliability of I131-Triolein Test in the Detection of Steatorrhea

The clinical approach to steatorrhea.

A practical approach to the detection of steatorrhea and its division into preabsorptive and postabsorptive disease has been presented. Emphasis has been placed upon study of the stool for microscopic fat, the oral glucose tolerance test, the gastrointestinal series, and the response to therapy in the differentiation of most diseases associated with steatorrhea. The necessity for considering steatorrhea in every patient with diarrhea has been underlined.