Hello and thank you for posting your health query on E health Forum.
The fecal fat test measures the amount of fat in the stool, which helps estimate the percentage of dietary fat that the body does not absorb.
A high fecal fat excretion indicates fat malabsorption.
The underlying cause could be due to Pancreatic insufficiency, Defective stimulation of the stomach with decreased contractility, decreased acid secretion in the stomach, gall bladder or liver disease, Intestinal bacterial overgrowth, Food allergies such as celiac disease, Inflammatory bowel disease, Parasitic infections (Whipple's disease or tropical sprue), Lack of enzymes in the intestine (lactase deficiency), etc.
Diagnosing the cause of malabsorption is difficult, and doctors will try many different testing approaches. A biopsy of the intestinal mucosa (if not done until now) can give additional information on your condition.
For the time being you can take pancreatic enzyme supplements, probiotics, in addition to following a strict low fat diet will be helpful.
You might consider to continue working with your gastroenterologist for proper evaluation and diagnosis.
I hope this helps.