Tropical sprue pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
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Overview
TS causes mucosal abnormalities of the small intestine leading to intestinal malabsorption and multiple nutritional deficiencies. Although, the precise etiology of the disease is unknown, many studies have observed small intestinal bacterial overgrowth and prior episodes of infectious gastroenteritis in patients with TS, suggesting infection, as the possible etiology of TS.
Pathophysiology
Infection
- Accompanied by Fever at the onset of the disease
- Increase in the gram-negative bacterial toxins and bacterial colony counts
- Precipitated by a history of acute gastroenteritis.[1]
- There is an increase in the inflammatory cells in the lamina propria with variable edema
- Good clinical response to Tetracycline with restoration of the normal histology.
Bacterial overgrowth leading to toxin production.[2]
Histology
The histological changes of TS include: Flattening of the villi and small intestinal inflammation which are similar to an autoimmune disorder Coeliac disease (also known as coeliac sprue).
| Diagnosis | Villous morphology | Findings in Lamina propria | Involved portion of the GI tract |
|---|---|---|---|
| Tropical sprue | Mild to moderate blunting of the villi with an increased number of Intraepithelial lymphocytes. | Increased number of plasma cells and eosinophils. | Ileum > Duodenum > Colon |
| Celiac sprue | Variable, often there is a complete flattening of the villi. Always there is an increased number of Intraepithelial lymphocytes | Plasma cells > Eosinophils > Neutrophils. | Duodenum > Ileum. |
References
- ↑ McCarroll MG, Riddle MS, Gutierrez RL, Porter CK (2015). "Infectious Gastroenteritis as a Risk Factor for Tropical Sprue and Malabsorption: A Case-Control Study". Dig Dis Sci. 60 (11): 3379–85. doi:10.1007/s10620-015-3768-8. PMID 26115751.
- ↑ Walker, Marjorie M (2003). "What is tropical sprue?". Journal of Gastroenterology and Hepatology. 18 (8): 887–890. doi:10.1046/j.1440-1746.2003.03127.x. ISSN 0815-9319.