Summary
Definition
History and exam
Key diagnostic factors
- prolonged exposure to an endemic area
- constitutional symptoms
- diarrhea
- bloating
- foul-smelling, greasy stools
- glossitis
- numbness of fingers and toes
Other diagnostic factors
- 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
Risk factors
- prolonged exposure to an endemic area
- HLA antigen in the Aw-19 series
Diagnostic investigations
1st investigations to order
- CBC
- quantitative fecal fat assay
- D-xylose test
- serum folate
- serum vitamin B12
Investigations to consider
- stool ova and parasites (O and P)
- stool culture
- upper gastrointestinal endoscopy with biopsy
- folic acid therapeutic trial
Treatment algorithm
tropical sprue symptoms
Contributors
Authors
Daniel Wild, MD
Professor of Medicine
Division of Gastroenterology
Duke University Medical Center
Durham
NC
Disclosures
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
Disclosures
ILV declares that she has no competing interests.
Acknowledgements
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.
Peer reviewers
J. Thomas LaMont, MD
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.
Daniel Leffler, MD, MS
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.
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
Disclosures
PC declares that he has no competing interests.
Differentials
- Parasitic infections: Strongyloides, Isosporiasis, Giardia lambia, Entamoeba histolytica, Cyclosporiasis
- Bacterial infections: Shigella, Salmonella, Escherichia coli
- HIV enteropathy
More DifferentialsGuidelines
- American Society for Gastrointestinal Endoscopy guideline on informed consent for GI endoscopic procedures
More Guidelines
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer