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| __NOTOC__ | | __NOTOC__ |
| {{Tropical sprue}} | | {{Tropical sprue}} |
| {{CMG}}; {{AE}} {{SCh}} | | {{CMG}}; {{AE}} |
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| {{SK}} Chronic diarrhea, Intestinal malabsorption, Tropical malabsorption, Postinfective tropical malabsorption, Postinfective malabsorption, Tropical enteropathy, Tropical diarrhea, Military diarrhea, Cachectic diarrhea, Psilosis, Aphthae tropical, Chronic traveller's diarrhea, Tropical steatorrhea, Chronic malabsorption.
| | ==Overview== |
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| ==Overview==
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| '''Tropical sprue''' is an acquired [[malabsorption]] disease of unknown etiology commonly found in the tropical regions, marked with abnormal flattening of the [[villi]] and [[inflammation]] of the lining of the [[small intestine]]. Ghoshal et al. defined a group of patients with TS by strict clinical and pathological criteria and show that [[aerobic bacteria]] contaminate the small bowel in patients with TS and that these patients have a prolonged orocecal transit time (OCTT) compared with healthy control subjects. It differs significantly from [[coeliac sprue]].
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| ==Historical Perspective== | | ==Historical Perspective== |
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| ==Pathophysiology== | | ==Pathophysiology== |
| TS is an acute infection of the digestive tract and is known to cause damage to the small bowel mucosa, disrupting gastrointestinal hormone balance resulting in slowing of gastrointestinal motility and subsequent bacterial overgrowth.
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| ==Causes== | | ==Causes== |
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| ==Diagnosis== | | ==Diagnosis== |
| Exclusion of other diarrheal etiologies is required for the diagnosis of TS.
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| ===Diagnostic Criteria=== | | ===Diagnostic Criteria=== |
| Tropical sprue is a diagnosis of exclusion, it is usually considered in returning traveller's presenting with persistent diarrhea. Following signs may be indicative of TS:
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| * Abnormal flattening of the [[villi]] and inflammation of the lining of the small intestine, observed during an [[endoscopy|endoscopic]] procedure.
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| * Presence of inflammatory cells in the [[biopsy]] of small intestine tissue.
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| * Low levels of vitamins [[vitamin A|A]], [[vitamin B12|B12]], [[vitamin E|E]], [[vitamin D|D]], and [[vitamin K|K]], as well as [[serum albumin]], [[calcium]], and [[folate]], revealed by a blood test.
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| * Excess fat in the [[feces]] (steatorrhoea).
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| ===History and Symptoms=== | | ===History and Symptoms=== |
| TS has been defined as malabsorption of two or more substances(Carbohydrate,fat,vitamin B12) in people from the tropics when other known causes have been excluded. Klipstein characterized tropical sprue as jejunal morphologic abnormalities accompanied by malabsorption of two distinct substances, and having the following distinct features:<br>
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| 1) gastrointestinal symptoms<br>
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| 2) relentless worsening unless treatment is instituted;<br>
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| 3) nutritional deficiency in all patients with advanced disease, regardless of dietary intake;<br>
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| 4) failure of the morphologic abnormalities to improve with emigration to a temperate zone; and<br>
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| 5) consistent response to folic acid and/or tetracycline.<br><ref name="Lim2001">{{cite journal|last1=Lim|first1=Matthew L.|title=A perspective on tropical sprue|journal=Current Gastroenterology Reports|volume=3|issue=4|year=2001|pages=322–327|issn=1522-8037|doi=10.1007/s11894-001-0055-y}}</ref>
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| ===Physical Examination=== | | ===Physical Examination=== |
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| ==Treatment== | | ==Treatment== |
| ===Medical Therapy=== | | ===Medical Therapy=== |
| The cornerstone of treatment for TS includes folic acid replenishment, with or without Tetracyclines. Recommended regimens include Tetracycline, 250 mg four times a day, or doxycycline, 100 mg twice a day, for 3 to 6 months. Treatment with folic acid and tetracycline was not as effective in the setting of epidemic tropical sprue in India, suggesting that the southern India variant may be pathologically distinct. Response to treatment may be dramatic, with suppression of bacterial growth and improvement in absorption within 24 hours. However, both clinical improvement and jejunal morphologic changes may lag considerably. Maldonaldo et al. demonstrated that sulfonamide therapy is effective in tropical sprue patients treated for 6 months. Long-term followup suggests that a minority of patients treated with folic acid and tetracyclines may relapse, even after leaving a tropical area.<ref name="Lim2001">{{cite journal|last1=Lim|first1=Matthew L.|title=A perspective on tropical sprue|journal=Current Gastroenterology Reports|volume=3|issue=4|year=2001|pages=322–327|issn=1522-8037|doi=10.1007/s11894-001-0055-y}}</ref>
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| ===Surgery=== | | ===Surgery=== |