Tropical sprue pathophysiology
|
Tropical sprue Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Tropical sprue pathophysiology On the Web |
|
American Roentgen Ray Society Images of Tropical sprue pathophysiology |
|
Risk calculators and risk factors for Tropical sprue pathophysiology |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Please help WikiDoc by adding content here. It's easy! Click here to learn about editing.
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]
| Differences in presentation between Indian and Caribbean TS | |
|---|---|
| Indian | Caribbean |
| No association with small bowel colonization | Associated with small bowel colonization |
| Small bowel transit time is not prolonged | Prolonged small bowel transit time |
| Higher mortality | Lower mortality |
| Spontaneous remissions common | Spontaneous remissions rare |
| Fever present in 25% of cases | Fever- rare |
| Variable response to folic acid and antibiotics | Good response to folic acid and antibiotics |
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.