Tropical sprue overview

Jump to navigation Jump to search

Tropical sprue Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Tropical sprue from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Tropical sprue overview On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Tropical sprue overview

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Tropical sprue overview

CDC on Tropical sprue overview

Tropical sprue overview in the news

Blogs on Tropical sprue overview

Directions to Hospitals Treating Tropical sprue

Risk calculators and risk factors for Tropical sprue overview

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

  1. 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.

Template:WS Template:WH