Intestinal Absorption of Tritium-Labelled Folic Acid in Idiopathic Steatorrhea: Effect of a Gluten-Free Diet

The intestinal absorption of folic acid in patients with idiopathic steatorrhea was studied by the oral administration of tritium-labelled folic acid in a dosage of 15 μg./kg. Results were expressed as a percentage of the orally administered folic acid radioactivity excreted in the urine over 24 hours. The mean excretion of radioactivity in 38 normal subjects was 48.2 ± 16.6% (mean ± SD), whereas eight patients with untreated idiopathic steatorrhea excreted only 16.7 ± 3.4% (mean ± SE).The ability of the gluten-free diet to correct this absorptive defect was demonstrated by the finding of normal values in 11 patients in complete clinical remission for periods exceeding six months after institution of the diet. Serial studies in individual patients indicated that a significant improvement was obtainable in as short a period as two weeks following exclusion of gluten from the diet.     

Idiopathic Steatorrhea Presenting with Different Manifestations in Sisters

Although it is well known that the incidence of idiopathic steatorrhea is much higher in relatives of patients with this disease than it is in the general population, there has been little comment on the variability of symptoms in familial cases. Two sisters with this disease are reported. One presented with a relatively acute history of diarrhea, weight loss, fatigue and peripheral edema and was found to have a normal hemoglobin, hypocalcemia and a markedly decreased prothrombin activity. Her elder sister tended to constipation and had a 10-year history of refractory iron-deficiency anemia. The diagnosis was confirmed in both by peroral jejunal biopsy.     

Steatorrhea in patients with liver disease

Intestinal function was studied in 26 patients with seven types of acute and chronic liver disease, documented by liver biopsy. Steatorrhea, defined by a stool fat higher than 6 g. per day, was present in 18 of 23 consecutive patients studied, an incidence of 78.3%. Two patients with infectious hepatitis associated with steatorrhea studied previously were added and the 20 cases were analyzed. The malabsorption found was confined to fat and fat-soluble vitamins; stool excretion varied from 6.1 to 22 g. per day in the seven groups studied. No histological abnormality was seen on jejunal biopsy, serum vitamin B₁₂, D-xylose and Schilling tests were normal, and no radiological findings associated with malabsorption were detected in the small bowel. It is concluded that steatorrhea is a common finding in a wide variety of acute and chronic liver diseases and cannot be attributed to a primary defect of the small bowel.