PubMed · 7022720
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R P Hall, T J Lawley, S I Katz. 1981. Dermatitis herpetiformis.. https://doi.org/10.1007/bf01891883
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BACKGROUND: Olestra is a nonabsorbable fat substitute that consists of fatty acids esterified to a sucrose molecule. OBJECTIVE: To determine the effect of olestra consumption on measurements of fecal fat excretion. DESIGN: Controlled cross-over trial. SETTING: Clinical research center and outpatient research laboratory. PARTICIPANTS: 10 healthy volunteers. INTERVENTION: On days 1 to 6 of the study, participants consumed 5 oz of conventional potato chips per day; on days 7 to 12, they consumed 5 oz of potato chips containing 40 g of olestra per day. MEASUREMENTS: Quantitative measurement of fecal fat by the van de Kamer titration, van de Kamer gravimetric, and Jeejeebhoy gravimetric methods and qualitative assessment of fecal fat by Sudan III staining. RESULTS: Excellent correlation was seen among the three quantitative assays, but the van de Kamer titration method yielded lower measurements than the two gravimetric methods. When participants consumed 40 g of olestra per day, the excretion of fecal fat increased to levels observed in patients with steatorrhea caused by the malabsorption syndrome. CONCLUSION: Consumption of olestra can cause false-positive results on tests for steatorrhea and may therefore lead to an erroneous diagnosis of the malabsorption syndrome.
Studies from western countries have shown that coeliac disease (CD) is common with prevalence figures about 1:300. The clinical spectrum varies greatly, steatorrhoea and weight loss affecting less than half of the patients. CD should be suspected in case of positive gliadin (IgA and IgG) and endomysial (IgA) antibodies. The diagnosis is based upon histological examination of duodenal biopsies taken during upper gastrointestinal endoscopy. Most patients respond quickly and satisfactorily to treatment with a gluten-free diet. This treatment also eliminates the excess risk of small bowel malignancy. Screening among first degree relatives and patients with insulin-dependent diabetes mellitus should be considered.
Coeliac disease in adults is an overlooked and undiagnosed illness. We present a case where a woman was diagnosed at the age of 59 despite symptoms suggestive of coeliac disease since childhood. At the time of diagnosis the patient had severe osteomalacia with multiple vertebral fractures of the thoracic and lumbar spine.