Tropical sprue overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]
Synonyms and keywords: 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
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.
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Tropical sprue overview from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
Diagnosis
Exclusion of other diarrheal etiologies is required for the diagnosis of TS.
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:
- Abnormal flattening of the villi and inflammation of the lining of the small intestine, observed during an endoscopic procedure.
- Presence of inflammatory cells in the biopsy of small intestine tissue.
- Low levels of vitamins A, B12, E, D, and K, as well as serum albumin, calcium, and folate, revealed by a blood test.
- Excess fat in the feces (steatorrhoea).
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:
1) gastrointestinal symptoms
2) relentless worsening unless treatment is instituted;
3) nutritional deficiency in all patients with advanced disease, regardless of dietary intake;
4) failure of the morphologic abnormalities to improve with emigration to a temperate zone; and
5) consistent response to folic acid and/or tetracycline.
Physical Examination
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
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.[1]
Surgery
Prevention
References
- ↑ Lim, Matthew L. (2001). "A perspective on tropical sprue". Current Gastroenterology Reports. 3 (4): 322–327. doi:10.1007/s11894-001-0055-y. ISSN 1522-8037.