A severe malabsorption syndrome endemic in Asia, some Caribbean islands and parts of South America.
The condition occurs in epidemics and improves on antibiotics thus it is likely that it has an infective cause.
Patients present with diarrhoea, anorexia, abdominal distension and weight loss. The onset may be acute or insidious.
The diagnosis can be made on jejunal biopsy, there is colonisation of the gut lumen by toxin producing enterobacteria associated with partial villous atrophy.
Severely ill patients require resuscitation for dehydration and electrolyte imbalance. Nutritional deficiencies should be corrected and antibiotics given, but patients often improve when they leave endemic areas.