Summary
Definition
Tropical sprue (TS) is an acquired malabsorptive condition of probable infectious aetiology. Features include altered small bowel mucosa, chronic diarrhoea, and signs and symptoms of multiple vitamin and nutrient deficiencies. It is seen in both natives of, and long-term visitors to, specific endemic areas in the tropics.
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Tropical sprue; ridged and foveolar patterns, duodenum
From the collection of Dr M. Guelrud; used with permission
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Endoscopy, normal and tropical sprue (TS) villi changes, duodenum
From the collection of Dr M. Guelrud; used with permission
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Normal duodenum, standard endoscopy
From the collection of Dr M. Guelrud; used with permission
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Tropical sprue; scalloping, mosaic appearance, and mucosal grooves; duodenum
From the collection of Dr M. Guelrud; used with permission
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History and exam
Key diagnostic factors
- prolonged exposure to an endemic area
- constitutional symptoms
- diarrhoea
- bloating
- foul-smelling, greasy stools
- swollen/sore tongue and lips
- glossitis
- numbness of fingers and toes
Other diagnostic factors
- abdominal cramping
- fever
- leg swelling
- hair loss
- cheilitis/angular stomatitis
- pedal oedema
- hyperactive bowel sounds/borborygmi
- hyperpigmentation/eczematous rash
- pallor
- dry eyes
- corneal xerosis
- night blindness
- decreased deep tendon reflexes/decreased vibratory sensation
Diagnostic investigations
1st investigations to order
- FBC
- quantitative faecal fat assay
- D-xylose test
- serum folate
- serum vitamin B12
Investigations to consider
- stool ova and parasites (O and P)
- stool culture
- upper GI endoscopy with biopsy
- folic acid therapeutic trial
Treatment algorithm
Contributors
Authors VIEW ALL
Associate Professor of Medicine
Division of Gastroenterology
Duke University Medical Center
Durham
NC
Disclosures
DW declares that he has no competing interests.
Dr Daniel Wild would like to gratefully acknowledge Dr Moises Guelrud, a previous contributor to this monograph. MG declares that he has no competing interests.
Peer reviewers VIEW ALL
Professor of Medicine
Harvard Medical School
Division of Gastroenterology
Beth Israel Deaconess Medical Center
Boston
MA
Disclosures
JTLM declares that he has no competing interests.
Instructor in Medicine
Harvard Medical School
Director of Clinical Research
The Celiac Center
Beth Israel Deaconess Medical Center
Boston
MA
Disclosures
DL declares that he has no competing interests.
Professor of Gastroenterology
Department of Diabetes and Nutritional Sciences
Kings College London
Rayne Institute
St Thomas' Hospital
London
UK
Disclosures
PC declares that he has no competing interests.
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