This is an intestinal mal absorption syndrome affecting some people who live or who have lived in tropical areas. India, Pakistan, Burma, Sri Lanka, China, Indonesia and Puerto Rico are the most commonly affected countries. Some cases have been reported in North America, the West Indies, Southern Europe and the Middle East.
It commonly occurs in middle life, the sexes being equally affected. Nearly all have a history of tropical living for a period, although the attack may come on years later. The bowel fails to absorb fats and certain starches.
The main symptom is diarrhoea, with pale, frothy, foul-smelling and greasy bowel actions. A high-fat diet aggravates, as does stress. Indigestion, flatulence, abdominal cramps, weight loss (often marked), pallor and wasting take place. There is often irritability, abnormal sensations in the skin (paraesthesia) and muscle cramps. Vitamin deficiencies, abdominal distension and mild oedema (swelling of the extremities) may occur. As fat absorption is impaired, often the correct absorption of vitamins and other nutritional essentials starts to become impaired also.
Proper medical supervision is essential, both to form a diagnosis, and then to supervise the correct therapy. Control of the diarrhoea and replacement of vitamins and minerals and controlling complications such as dehydration are necessary.
Antibiotics (the tetracyclines) and the insoluble sulfonamides usually control the diarrhoea, but may have to be given for many months.
Folic acid often gives remarkably effective benefits for the intercurrent anaemia. Diet is also important.