Tropical sprue history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
History and Symptoms
| Symptom | Explanation | Stage of the disease |
|---|---|---|
| Diarrhea | Malabsorbed nutrients with osmotic diarrhea;colonic water secretion due to unabsorbed fatty acids. | |
| Pale, bulky foul-smelling stool | Fat malabsorption | |
| Borborygmi, abdominal fullness | Carbohydrate malabsorption | |
| Pedal edema, skin changes | Hypoproteinemia secondary to loss of mucosal surface, protein loss and pancreatic insufficiency. | |
| Pallor | Vitamin B12 and folate deficiency, rarely Ifron deficiency. | |
| Angular stomatitis, glossitis | Vitamin B deficiency | |
| Night blindness, corneal xerosis, Bitot's spots | Vitamin A deficiency | |
| Muscle weakness | Hypophosphataemia,hypokalemia,hypomagnesaemia | |
| Weight loss | Anorexia, malabsorption |
The symptoms of tropical sprue are:
- Diarrhoea with passage of 3-20 loose stools per day associated sometimes with the blood and mucus.
- Vague abdominal discomfort with occasional colicky abdominal pain is usually present.
- Steatorrhea or foul-smelling faeces
- Indigestion
- Cramps
- Weight loss and malnutrition
- Cachexia
- Fatigue
- Sore tongue
- Flatulent indigestion
- The diarrhea may be accompanied by nausea, anorexia, a feeling of fullness in the abdomen, loud borborygmi and occasionally severe vomiting.
- Nausea and vomiting diminishes with time but anorexia and abdominal dissension persists over time.
- In about a quarter of patients, the onset of diarrhea is preceded for 1 or 2 days by fever, malaise.
- Symptomatically, the course of the disease is frequently characterized by remissions and relapses. Periods of diarrhea with watery stools are often interspersed with periods of normal stools.
Left untreated, nutrient and vitamin deficiencies may develop in patients with tropical sprue. These deficiencies may have the following symptoms:
- Lassitude
- Weight loss
- Glossitis
- Stomatitis
- Night blindness
- Hyperpigmentation
- Muscle cramps
- Dependent edema
- Vitamin A deficiency: hyperkeratosis or skin scales
- Vitamin B12 and folic acid deficiencies: anaemia
- Vitamin D and calcium deficiencies: spasm, bone pain, numbness and tingling sensation
- Vitamin K deficiency: bruises
Signs
Diagnosis of tropical sprue can be complicated because many diseases have similar symptoms. Your doctor would look for the following signs:
- Abnormal flattening of villi and inflammation of the lining of the small intestine, observed during an endoscopic procedure.
- Presence of inflammatory cell 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).
Tropical sprue is largely limited to within about 30 degrees north and south of the equator. Therefore, if one resides outside of that geographical region, recent travel to the region is a key factor in diagnosing this disease.