Tropical sprue laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Laboratory Findings

All the patients with celiac disease unresponsive to gluten free diet, a diagnosis of tropical sprue must be considered. The lab findings are not specific for tropical sprue as it is a diagnosis of exlclusion.

• Patients with ileal involvement have low vitamin B12 and folate levels.
• Normal transglutaminase, immunoglobulin levels are present.
• Peripheral blood smear will demonstrate megaloblastic picture.

Approach to a Patient With Malabsorption in Tropical Region

Clinical suspicion of malabsoption syndrome

Initial screening perform: Hemogram Stool Microscopy to rule out infectious causes D-xylose test to rule out intestinal enterocyte dysfunction Fecal fat test to rule out steatorrhea

Confirmatory tests for malabsoption should be done

Antiendomysial antibodies and villous atrophy suggests celiac disease Breath test for lactase deficiency Microscopy and culture of jejunal aspirate for small bowel bacterial overgrowth Serum immunoglobulin for B-celll deficiency HIV serology CT enterography Abdomen CT to rule out chronic pancreatitis

Once other possibilities are ruled out, suspect diagnosis of tropical sprue

Start tetracycline therapy Improvement of symptoms with tetracycline confirms the diagnosis

References

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