Treatment of overt and subclinical malabsorption in Haiti TABLE

It is now recognized that abnormalities of small intestinal morphology and function in the tropics are found both in subjects with overt tropical sprue and in the asymptomatic indigenous population (Baker, Ignatius, Mathan, Vaish, and Chacko, 1962; Sprinz, Sribhibhadh, Gangarosa, Benyajati, Kundel, and Halstead, 1962; Lindenbaum, Alam, and Kent, 1966; Russell, Aziz, Ahmad, Kent, and Gangarosa, 1966; England and O'Brien, 1966). Previous studies in Haiti have indicated that such intestinal abnormalities are associated with a spectrum of clinical manifestations ranging from the asymptomatic state to overt tropical sprue (Klipstein, Samloff, and Schenk, 1966a). The aetiology of these intestinal changes in the asymptomatic subjects and their relationship to the lesion found in overt tropical sprue are uncertain. In some instances, protein malnutrition may be relevant to the aetiology of subclinical malabsorption (Mayoral, Tripathy, Garcia, Klahr, Bolafnos, and Ghitis, 1967); however, in those circumstances where protein malnutrition is absent, other factors must be invoked and it has been suggested that the intestinal lesion both in overt tropical sprue and in subclinical malabsorption may represent a reaction of the intestinal mucosa to similar, as yet unidentified, environmental factors (Klipstein, 1967). Treatment of subjects with overt tropical sprue, using either folic acid or oral tetracycline, is known to result in improvement in intestinal morphology and absorptive capacity with the consequent correction of nutritional deficiencies (Sheehy, Baggs, Perez-Santiago, and Floch, 1962; Guerra, Wheby, and Bayless, 1965; Klipstein, Schenk, and Samloff, 1966b; O'Brien and England, 1966). To date, no studies have been reported concerning the results of similar treatment in subjects with subclinical malabsorption in the tropics. The present report describes the results of such therapy in 23 Haitians, eight of whom had overt and 15 of whom had subclinical malabsorption. SUBJECTS STUDIED