Lentigines

Specialty: Gastrointestinal.

• Passage of undigested food in the feces
• lientericis
• stools with visible food remains

Why it occurs

• Severely accelerated intestinal transit secondary to rapid emptying syndrome (post-gastrectomy dumping syndrome)
• Severe exocrine pancreatic insufficiency with total loss of enzymatic digestion of macronutrients
• Gastrointestinal, gastrojejunal or upper gastrocolic fistula that short-circuits large segments of the small intestine
• Massive intestinal resection (short bowel syndrome) that critically decreases the contact time of chyme with enzymes and mucosa
• Osmotic diarrhea due to laxative abuse or excessive consumption of non-absorbable artificial sweeteners.

Initial workup

Complete functional coprology (microscopic analysis looking for remains of muscle fibers, starch and fat with Sudan III stain) | Quantification of fecal alpha-1-antitrypsin clearance (if protein-losing enteropathy is suspected) | Abdominal CT with oral contrast to map fistulas or anatomical abnormalities | Entero-MRI or barium transit to measure transit velocity and loop morphology | Analysis with blood count, albumin, prealbumin, electrolytes, iron profile, folate and cobalamin.

Standard management

• Exogenous pancreatic enzymes — lipase, amylase, enteric-coated protease, dose adapted according to the macronutrient content of the diet to optimize luminal digestion
• Intestinal motility inhibitors — loperamide 2-4 mg administered 30 minutes before main meals to slow transit and optimize intestinal absorption; or codeine phosphate 15-30 mg every 8 hours under close monitoring
• Octreotide (50-100 mcg subcutaneously every 8-12 hours, indicated in Dumping syndrome or refractory short intestine to delay gastric emptying and intestinal motility).