Tropical sprue

Last reviewed: 6 Jun 2022
Last updated: 01 Apr 2022

Summary

Definition

History and exam

Key diagnostic factors

  • prolonged exposure to an endemic area
  • constitutional symptoms
  • diarrhea
  • bloating
  • foul-smelling, greasy stools
  • swollen/sore tongue and lips
  • glossitis
  • numbness of fingers and toes
More key diagnostic factors

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
Other diagnostic factors

Risk factors

  • prolonged exposure to an endemic area
  • HLA antigen in the Aw-19 series
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC
  • quantitative fecal fat assay
  • D-xylose test
  • serum folate
  • serum vitamin B12
More 1st investigations to order

Investigations to consider

  • stool ova and parasites (O and P)
  • stool culture
  • upper gastrointestinal endoscopy with biopsy
  • folic acid therapeutic trial
More investigations to consider

Treatment algorithm

ONGOING

tropical sprue symptoms

Contributors

Authors

Daniel Wild, MD

Associate Professor of Medicine

Division of Gastroenterology

Duke University Medical Center

Durham

NC

Disclosures

DW declares that he has no competing interests.

Acknowledgements

Dr Daniel Wild 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.

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