Tropical sprue: a riddle wrapped in a mystery inside an enigma

tropical countries in the last two centuries. Characterised by profuse diarrhoea, steatorrhoea, abdominal distension, mouth ulcers and weight loss, it is a malabsorption syndrome the aetiology of which has never been conclusively identified. The phrase “A riddle wrapped in a mystery inside an enigma (Winston Churchill)” applies very aptly to tropical sprue. During the period of European colonialism in India and southeast Asia, tropical sprue was considered to primarily affect expatriates from Western countries who visited the colonies and for a long time thereafter it has continued to be viewed principally from that angle. In fact, sprue, or an illness remarkably similar to it, was described many centuries ago in the Charaka Samhita as grahani vyadhi1. In the 1960s, tropical sprue was recognized to be a major cause of malabsorption in Indians both in adults and in children2-7. Epidemic forms of the disease occurred in southern India during the 1960s and killed as many as 35,000 people in a single epidemic8. In recent years the disease has been on the wane in India. However, it remains a significant cause of adult malabsorption in many parts of India9,10.