PATHOLOGIC FACTOES ALTERING DIGESTIBILITY OF FATS 245 



rather from a failure to absorb the fatty acids and soaps in the absence of 

 the solvent action of the bile salts. However, Heerschma and Annegers 13 * 

 were unable to improve the steatorrhea in bile fistula dogs by 3 g. doses of 

 certain bile preparations, including desoxycholic acid. While 90 ml. 

 doses of fresh ox bile reduced the steatorrhea by 50%, 6 g. doses of desic- 

 cated ox bile were only one-half as effective. In the case of obstructive 

 jaundice, the feces are bulky and pale in color, due both to the absence of 

 the bile pigments and to the increased proportion of fat excreted. 



(5) Non-tropical Sprue 



This disease also goes by the name of idiopathic steatorrhea. The stools 

 are frequent and voluminous, containing a large proportion of fats, fatty 

 acids, and soaps. This condition may lead to tetany, due to the continual 

 loss of calcium by way of the intestine. Frazer 139 is of the opinion that 

 this condition is due to a defect in particulate absorption of fat which may 

 possibly be related to an enzyme deficiency. However, French 140 ascribed 

 the reduced fat absorption in sprue to a depressed intestinal absorption. 

 In the case of pancreatic enzyme deficiency, the impairment of fat ab- 

 sorption is believed to result from failure of intraluminar emulsification in 

 the absence of lipolysis. On the othef hand, in sprue, the intraluminar 

 changes were found to be normal. The delayed glyceride absorption is 

 believed to cause an increased fatty acid formation, which results in aug- 

 mented mucus formation. It is suggested that this increased mucus 

 secretion, together with a decrease in intestinal motility and changes in 

 the intestinal flora, may all play a role in the sprue syndrome. In addi- 

 tion to non-tropical sprue, the sprue syndrome includes tropical sprue, 139,141 

 and celiac disease in children. 142 Annegers 143 originally pointed out that 

 this defect in fat absorption in these conditions resembles the syndrome 

 observed in patients and experimental animals deprived of bile. How- 

 ever, he 144 later expressed doubt of this viewpoint, on the basis of the fact 

 that Tween 80 failed to reduce the fecal fat excretion in bile fistula dogs. 

 On the other hand, much smaller doses of Tween 80 had been found to be 

 effective in celiac disease. 146 



138 J. R. Heerschma and J. H. Annegers, Proc. Soc. Exptl. Biol. Med., 67, 339-341 

 (1948). 



139 A. C. Frazer, Brit. Med. J., 2, 769-773 (1949). 



140 J. M. French, Biochem. J., 61, xiv (1952). 



141 N. H. Fairley, Trans. Roy. Soc. Trop. Med. Hyg., 80, 9-32 (1936). 



142 L. G. Parsons, Am. J. Diseases Children, 43, 1293-1346 (1932). 



143 J. H. Annegers, Quart. Bull. Northwestern Univ. Med. School, 28, 198-206 (1949). 



144 J. H. Annegers, Proc. Soc. Exptl. Biol. Med., 81, 277-278 (1952). 



145 H. Boyd and F. Helfrick, J. Pediat., 88, 493-497 (1951). 



