Idiopathic Steatorrhoea.

A NEW chapter in the story of idiopathic steatorrhoea was opened by the discovery of the various biopsy tubes which are swallowed by the patient and take either single specimens from the duodenum or jejunum (Shiner, 1956; Crossby and Kugler, I957) or, more recently, retrieve several samples from any level in the small bowel (Brandborg, Rubin and Quinton, 1959; Baker and Hughes, 1960). This allows more exact diagnosis and increases the chance of separating idiopathic steatorrhoea from the numerous disorders of the small gut which can cause an identical pattern of symptoms and nutritional effects; it also enables study of the intestinal cell with the electron microscope and by histochemical methods. The main clinical features have been well defined (see Fig. i), but the nomenclature threatens to become as protean as its symptoms. The name of a disease is seldom satisfactory and is often a target for criticism, particularly as advancing knowledge sheds new light on the aetiology, or new treatment becomes effective. The defect of absorption involves all nutrients including fats, protein, carbohydrates, vitamins, minerals and water; so that the term steatorrhcea is too limited in outlook. 'Primary malabsorption syndrome' is the diagnosis preferred in the United States, a label which runs the risk of abbreviation to P.M.S. Many, however, would regard malabsorption as too limitless a term; not only might pernicious anaemia be an example of the primary malabsorption syndrome, but this could include diseases with increased absorption as of iron in haemachromatosis. Non-tropical sprue may imply too close an association with tropical sprue, and the cause is almost certainly quite different. Adult cteliac disease is certainly true for many patients; but the future may show different causes for others. Similarly, it is too soon to change to the term gluten-induced enteropathy. Many are dramatically cured by withdrawal of gluten but others, with an indistinguishable clinical picture, are not; nor is it known whether the gluten sensitivity is the primary cause of the disease, or a secondary phenomenon. So, for the present, 'idiopathic steatorrhea ' will suffice; the term ' steatorrhcea' emphasises the common denominator of this Incidence In Patients (i)