Disordered gastro-intestinal function and its relationship to tropical sprue, coeliac disease and idiopathic steatorrhoea

(1) Studies of gastro-intestinal function in 10 cases of tropical sprue, 10 cases of coeliac disease and 24 cases of idiopathic steatorrhoea are described. (2) All the cases showed delay and depression of intestinal absorption. (3) Radiographic studies revealed excessive mucus secretion and decreased intestinal tone and motility in all three conditions. (4) Pancreatic enzymes were normal. (5) It is concluded that functional incapacity of the small intestine is the basic pathological fault in tropical sprue, coeliac disease and idiopathic steatorrhoea. (6) Delayed and depressed absorption may cause a calorie deficit, increased growth of intestinal bacteria and modification of intestinal contents. These changes may be responsible for the main features of the syndromes observed. (7) The relationship of possible primary aetiological factors to this basic intestinal fault is reviewed. Adrenal insufficiency, climatic factors and vitamin deficiency do not seem to be primary factors. Infection and hereditary factors may have a causative role in any of the three conditions. Rancid fats may be important in tropical sprue. Dietary wheat gluten is a factor of major importance in coeliac disease.