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Tropical sprue

 

Tropical sprue is a condition that occurs in people who live in or visit tropical areas. It impairs nutrients from being absorbed from the intestines.

Tropical sprue (TS) is a syndrome characterized by acute or chronic diarrhea, weight loss, and malabsorption of nutrients.

This disease is caused by damage to the lining of the small intestine. It comes from having too much of certain types of bacteria in the intestines.

Risk factors are:

  • Living in the tropics
  • Long periods of travel to tropical destinations

Symptoms

 

Symptoms include:

  • Abdominal cramps
  • Diarrhea, worse on a high-fat diet
  • Excess gas (flatus)
  • Fatigue
  • Fever
  • Leg swelling
  • Weight loss

Symptoms may not appear for up to 10 years after leaving the tropics.

 

Exams and Tests

 

There is no clear marker or test that clearly diagnoses this problem.

Certain tests help to confirm that poor absorption of nutrients is present:

  • D-xylsoe is a lab test to see how well the intestines absorb a simple sugar
  • Tests of the stool to see if fat is absorbed correctly
  • Blood tests to measure iron, folate, vitamin B12, or vitamin D.
  • Complete blood count (CBC)

Test that examine the small intestine may include:

  • Enteroscopy
  • Upper endoscopy
  • Upper GI series

 

Treatment

 

Treatment begins with plenty of fluids and electrolytes. Replacement of folate, iron, vitamin B12, and other nutrients may also be needed. Antibiotic therapy with tetracycline or Bactrim is typically given for 3 to 6 months.

In most cases, oral tetracycline is not prescribed for children until after all the permanent teeth have come in. This medicine can permanently discolor teeth that are still forming. However, other antibiotics can be used.

 

Outlook (Prognosis)

 

The outcome is good with treatment.

 

Possible Complications

 

Vitamin and mineral deficiencies are common.

In children, sprue leads to:

  • Delay in the maturing of bones (skeletal maturation)
  • Growth failure

 

When to Contact a Medical Professional

 

Call your health care provider if:

  • Tropical sprue symptoms get worse or do not improve with treatment.
  • You develop new symptoms.
  • You have diarrhea or other symptoms of this disorder for a long period of time, especially after spending time in the tropics.

 

Prevention

 

Other than avoiding living in or traveling to tropical climates, there is no known prevention for tropical sprue.

 

 

References

Ramakrishna BS. Tropical diarrhea and malabsorption. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 108.

Semrad CE. Approach to the patient with diarrhea and malabsorption In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 140.

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    Tests for Tropical sprue

     
       

      Review Date: 10/27/2015

      Reviewed By: Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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