Summary
Definition
History and exam
Key diagnostic factors
- prolonged exposure to an endemic area
- constitutional symptoms
- diarrhea
- bloating, abdominal fullness, borborygmi
- foul-smelling, greasy stools
- glossitis, cheilitis/angular stomatitis
- numbness of fingers and toes
Other diagnostic factors
- fever
- leg swelling
- hair loss
- 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 tests
1st tests to order
- CBC
- quantitative fecal fat assay
- D-xylose test
- serum folate
- serum vitamin B12
Tests 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
Lauren Pioppo Phelan, MD
Assistant Professor of Medicine
Duke University Medical Center
Durham, NC
Disclosures
LPP declares that she 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 Lauren P. Phelan and Dr Iris L. Vance would like to gratefully acknowledge Dr Daniel Wild and Dr Moises Guelrud, the previous contributors to this topic. DW and MG declare that they have 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.
Yassmeen Abdel-Aty, MD
Assistant professor
University of South Florida
Florida, FL
Disclosures
YAA 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.
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.
References
Key articles
Keele KD, Bound JP. Sprue in India: a clinical survey of 600 cases. BMJ. 1946 Jan 19;1:77-81.
Sheehy TW, Cohen WC, Wallace DK, et al. Tropical sprue in North Americans. JAMA. 1965 Dec 6;194(10):1069-76.
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 Dec;57:892-908.
Suarez RM, Spies TD, Suarez RM Jr. The use of folic acid in sprue. Ann Intern Med. 1947 May;26(5):643-77.
Rickles FR, Klipstein FA, Tomasini J, et al. Long-term follow-up of antibiotic-treated tropical sprue. Ann Intern Med. 1972 Feb;76:203-10.
Guerra R, Wheby MS, Bayless TM. Long-term antibiotic therapy in tropical sprue. Ann Intern Med. 1965 Oct;63:619-34.
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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