Persistent Oily Stools: Do I Need Further Tests for Digestive Issues?

Floating stools with oil have been evaluated through various tests. I would like to ask if any further examinations are necessary?

The patient has been experiencing long-term pain in the right upper abdomen and has had unformed stools.
Recently, the stools have been floating and oily for several months, and the patient's weight has decreased from 58 kg to 54 kg over the past six months.
Therefore, the patient opted for a comprehensive health check-up at their own expense.
Gastroscopy and colonoscopy revealed gastroesophageal reflux disease, duodenal ulcer, and hemorrhoids.
An abdominal ultrasound showed no issues, while a self-paid MRI detected a 0.3 cm benign cyst in the liver, with no other problems noted.
The patient has taken digestive enzymes "Sutai Xiao" and "Youmiao Hua," but the oily stools have not improved and have actually increased.
The patient would like to know if further examinations are necessary and what other potential issues could be present.
Thank you.

David, 30~39 year old female. Ask Date: 2021/12/25

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, a 38-year-old male presents with floating stools.
His diet is not excessively greasy, and stool tests can be conducted to check for steatorrhea.
Floating stools are associated with diet, medications, and gastrointestinal, liver, gallbladder, and pancreatic diseases.
Both gastroscopy and colonoscopy show no issues.
An abdominal MRI can be used to assess for pancreatic problems.
It is recommended to test the stool for fat content, and if imaging shows abnormalities, further follow-up and blood tests should be conducted.
It is important to avoid a high-fat diet or certain medications and supplements that may cause fat malabsorption.
If there is weight loss and persistent steatorrhea, outpatient follow-up and appropriate testing should be arranged.
Wishing you health and safety.
Sincerely, Dr.
Ming-Hui Lin, Attending Physician, Gastroenterology Department, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2021/12/25

More Info

Persistent oily stools, also known as steatorrhea, can be a concerning symptom that may indicate underlying digestive issues. Given your history of right upper abdominal pain, unformed stools, and significant weight loss, it is essential to consider a comprehensive evaluation to identify the root cause of these symptoms.

The presence of oily stools typically suggests malabsorption, which can occur due to various conditions affecting the digestive system. Some common causes of steatorrhea include pancreatic insufficiency, celiac disease, liver disease, and certain infections. In your case, the tests you have already undergone, including gastroscopy and colonoscopy, have revealed gastroesophageal reflux disease (GERD), duodenal ulcers, and hemorrhoids, but they did not directly address the potential causes of malabsorption.

The fact that you have been taking digestive enzymes without improvement in your symptoms raises the possibility that your issue may not solely be related to enzyme deficiency. It is crucial to consider other factors that could be contributing to your symptoms. For instance, pancreatic insufficiency, where the pancreas does not produce enough digestive enzymes, could lead to malabsorption and oily stools. A specific test to evaluate pancreatic function, such as a fecal elastase test, may be warranted.

Additionally, since you have undergone imaging studies that revealed a benign liver cyst, it is essential to ensure that there are no other liver-related issues, such as cholestasis or biliary obstruction, which could also lead to steatorrhea. A liver function test and possibly an ultrasound of the biliary tree could help rule out these conditions.

Celiac disease is another potential cause of malabsorption and should be considered, especially if you have any gastrointestinal symptoms such as bloating, diarrhea, or abdominal pain. A blood test for specific antibodies (tTG-IgA and EMA) can help screen for this condition, and if positive, an intestinal biopsy may be necessary for confirmation.

Given your weight loss of 4 kg over six months, it is essential to address this issue promptly. Unintentional weight loss can be a sign of a more serious underlying condition, and further evaluation is warranted. In addition to the tests mentioned above, it may be beneficial to consult with a gastroenterologist who can provide a more comprehensive assessment and guide you through the necessary diagnostic steps.

In summary, while you have already undergone several tests, the persistence of your symptoms suggests that further evaluation is needed. Consider discussing the following with your healthcare provider:
1. Fecal elastase test to assess pancreatic function.

2. Liver function tests and possibly imaging of the biliary system to rule out liver-related causes.

3. Celiac disease screening through blood tests.

4. A referral to a gastroenterologist for a more detailed evaluation and management plan.

It is crucial to address these symptoms proactively to ensure that any underlying conditions are identified and treated appropriately. Remember, persistent digestive issues should not be ignored, and seeking further medical advice is a vital step in your health journey.

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