Idiopathic steatorrhea

Carbohydrate Malabsorption 318 The Dumping Syndrome 318 Steatorrhea Idiopathic Steatorrhea Celiac Disease or Nontropical Sprue... 

Malabsorption syndrome Steatorrhea Tropical sprue Idiopathic hypercalcemia... 

Effects in Patients with Idiopathic Steatorrhea and Tropical Sprue. 89... 

As already mentioned, it is difficult to assess the effect of reintroduction of gluten into patients that are only partially recovered, since there are commonly large daily fluctuations in the fecal fat level. For the present it seems wise to retain the term idiopathic steatorrhea to cover these patients and to accept the view that they may exhibit varying degrees of gluten intolerance. 

The main points of differentiation are summarized in Table 2. It will be seen that the group can be divided up into gluten-induced enteropathy, acute sprue, chronic sprue and idiopathic steatorrhea. As the cause of the sudden development of severe folic add deficiency... 

Gluten-induced enteropathy Acute sprue Chronic sprue Idiopathic steatorrhea... 

V5. van Roon, J. H., Haex, A. J. Ch., Seeder, W. A., and de Jong, J., Clinical and biochemical analysis of gluten-toxicity. II. Clinical experiments on patients suffering from idiopathic steatorrhea after the administration of bromine treated performic acid oxidized polypeptides originating from wheat gluten. Gastroenterologia 94, 227-235 (1960). 

Glucocorticoid antagonism Idiopathic hypercalcemia Malabsorption syndrome Sarcoidosis Steatorrhea Tropical sprue... 

Patients with alcoholic CP usually present with an initial acute attack followed by successive attacks that are slower to resolve. Continued alcohol use leads to chronic abdominal pain and progressive exocrine and endocrine insufficiency. In about 50% of patients, the pain diminishes 5 to 10 years after the onset of symptoms. Steatorrhea, calcification, and diabetes usually develop after 10 to 20 years of heavy ethanol ingestion. Most patients present with varying degrees of pain, malnutrition, and glucose intolerance. The mortality rate of CP is approximately 50% within 20 to 25 years of the diagnosis. About 15% to 20% actually die of complications associated with acute attacks. Most deaths occur as a consequence of malnutrition, infection, or ethanol, narcotic, and tobacco nse. The clinical course of idiopathic CP is more favorable than that of alcoholic pancreatitis. ... 

Patients with hypoparathyroidism, whether surgical (Posen, unpublished) or idiopathic (C12, K24), have normal serum alkaline phosphatase values. Steatorrhea (M23) and hepatic cirrhosis (K37) may be associated with idiopathic hypoparathyroidism and serum alkaline phosphatase elevation. Hyperphosphatasemia has been reported in some (C24) but not all (RSS) patients with pseudohypoparathyroidism. 

To understand idiopathic steatorrhea, it is necessary to review some of the basic properties of the gastrointestinal tract— the rate of proliferation of the epithelium, the biochemistry of the intestinal epithelium, and the bacterial flora contained in the intestinal lumen [143-146]. 

When fat splitting and absorption is normal the ingestion of fats has in general been found to aid calcium absorption. In conditions in which there is excessive fat excretion, however, such as sprue or idiopathic steatorrhea, calcium is lost in the feces as calcium soaps. It has also been suggested... 

Absorption of fat is seriously impaired in man in the absence of bile from the intestinal tract, for example, in obstructive jaundice, although splitting of fat to fatty acids and glycerol proceeds normally. In sprue, idiopathic steatorrhea, and the celiac syndrome, fat is also poorly absorbed, although there is no decrease in available bile and the enzymatic breakdown to fatty acids is unimpaired. It has been suggested that a defective phosphorylating mechanism, due to deficiency of one or more vitamins of the B complex, may account for poor absorption in the sprue syndrome. Folic acid may be one of the factors involved. 

Megaloblastic Anemia Associated with Idiopathic Steatorrhea. 192... 

Megaloblastic anemia in young adults should always arouse suspicion of idiopathic steatorrhea, even if there is no diarrhea. This is particularly true if free hydrochloric acid is present in the gastric juice or if the response to Bu is slight or absent. Nieweg (1953) observed responses to Bi2 in two of his patients and a partial response in another. Two responded to folic acid. 

In tropical climates this is due mainly to chronic dietary deficiency as described in the foregoing pan aphs. Megaloblastic anemia may arise or recur during pregnancy in patients who already have latent Addisonian pernicious anemia or idiopathic steatorrhea, the pregnancy being either incidental or providing an additional drain on already depleted reserves. 

In any event, this and related syndromes (celiac disease, also known as nontropical sprue or idiopathic steatorrhea), call attention to an almost completely neglected aspect of folic metabolism— the glutamyl chains in the native folic coenzymes. 

---