Resumen
定义
病史和体格检查
关键诊断因素
- prolonged exposure to an endemic area
- constitutional symptoms
- diarrhea
- bloating
- foul-smelling, greasy stools
- glossitis
- numbness of fingers and toes
其他诊断因素
- abdominal cramping
- fever
- leg swelling
- hair loss
- cheilitis/angular stomatitis
- pedal edema
- hyperactive bowel sounds/borborygmi
- hyperpigmentation/eczematous rash
- pallor
- dry eyes
- corneal xerosis
- decreased deep tendon reflexes/decreased vibratory sensation
- night blindness
危险因素
- prolonged exposure to an endemic area
- HLA antigen in the Aw-19 series
诊断性检查
首要检查
- CBC
- quantitative fecal fat assay
- D-xylose test
- serum folate
- serum vitamin B12
需考虑的检查
- stool ova and parasites (O and P)
- stool culture
- upper gastrointestinal endoscopy with biopsy
- folic acid therapeutic trial
治疗流程
tropical sprue symptoms
撰稿人
作者
Daniel Wild, MD
Professor of Medicine
Division of Gastroenterology
Duke University Medical Center
Durham
NC
利益声明
DW declares that he has no competing interests.
Iris L. Vance, MD
Assistant Professor of Medicine
Division of Gastroenterology
Duke University Medical Center
Durham
NC
利益声明
ILV declares that she has no competing interests.
鸣谢
Dr Daniel Wild and Dr Iris L. Vance would like to gratefully acknowledge Dr Moises Guelrud, a previous contributor to this topic. MG declares that he has no competing interests.
同行评议者
J. Thomas LaMont, MD
Professor of Medicine
Harvard Medical School
Division of Gastroenterology
Beth Israel Deaconess Medical Center
Boston
MA
利益声明
JTLM declares that he has no competing interests.
Daniel Leffler, MD, MS
Instructor in Medicine
Harvard Medical School
Director of Clinical Research
The Celiac Center
Beth Israel Deaconess Medical Center
Boston
MA
利益声明
DL declares that he has no competing interests.
Paul Ciclitira, MBBS, MD, PhD
Professor of Gastroenterology
Department of Diabetes and Nutritional Sciences
King's College London
Rayne Institute
St Thomas' Hospital
London
UK
利益声明
PC declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Keele KD, Bound JP. Sprue in India: a clinical survey of 600 cases. BMJ. 1946;1:77-81.
Sheehy TW, Cohen WC, Wallace DK, et al. Tropical sprue in North Americans. JAMA. 1965;194:1069-1076. 摘要
Sheehy TW, Baggs B, Perez-Santiago E, et al. Prognosis of tropical sprue. A study of the effect of folic acid on the intestinal aspects of acute and chronic sprue. Ann Intern Med. 1962;57:892-908. 摘要
Suarez RM, Spies TD, Suarez RM Jr. The use of folic acid in sprue. Ann Intern Med. 1947;26:642-677.
Rickles FR, Klipstein FA, Tomasini J, et al. Long-term follow-up of antibiotic-treated tropical sprue. Ann Intern Med. 1972;76:203-210. 摘要
Guerra R, Wheby MS, Bayless TM. Long term antibiotic in tropical sprue. Ann Intern Med. 1965;63:619-634. 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Parasitic infections: Strongyloides, Isosporiasis, Giardia lambia, Entamoeba histolytica, Cyclosporiasis
- Bacterial infections: Shigella, Salmonella, Escherichia coli
- HIV enteropathy
更多 鉴别诊断指南
- American Society for Gastrointestinal Endoscopy guideline on informed consent for GI endoscopic procedures
更多 指南
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