The Aetiology of Tropical Sprue as Seen in Hong Kong and its Relation to Coeliac Disease

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SUMMARY: Over a period of twenty years the writer has been concerned in the study of tropical sprue and to a lesser extent, adult coeliac disease. The aetiology of coeliac disease is known, and Professor Booth in his Oliver-Sharpey lecture has suggested a hypothesis for the pathogenesis of gluten in that disease. Evidence is here presented that the production of oxidative rancidity in unsaturated cooking fats, exposed to the heat of a tropical humid atmosphere is aetiologically significant in tropical sprue as seeR in Hong Kong. It is believed that the toxic products of the rancid fat exert the same effect as gluteu does in coeliac disease. This paper discusses some possible aetiological factors in tropical sprue as seen in Hong Kong emphasising the ingestion of rancid fats as the main one. It indicates a close relationship between that disease and coeliac disease, suggesting that the main differences are:The specific noxious factor causing the small intestinal cell damage, and In the case of coeliac disease, the relatively longer period of exposure to the noxious substance. It is based on the writer's experience of tropical sprue when he served in Hong Kong from 1950 to 1954, and 1958 to 1961 (Webb 1956, and Webb and Simpson 1966). In the intervening years he has had the opportunity of studying coeliac disease both in England and Germany (Webb and Reploh 1969). Since Dicke's (1950) classical observations in Holland it has been confirmed that coeliac disease, occurring in children and adults, is produced by gluten, which is found in wheat and rye flour, causing damage to the absorbing cell of the small intestine in certain individuals. Precisely why a normal dietary constituent should affect selected persons is not understood. A process by which this damage is effected has been suggested by Booth (1970) in his Oliver-Sharpey Lecture and it is this lecture which stimulated the author to put his thoughts on the aetiology of tropical sprue to paper, and in so doing indicate the relationship stated above. The similarity of the clinical features occurring in tropical sprue and coeliac disease which together form the majority of the causes of malabsorption is shown in Table I.