Tropical sprue

Answer 1

Definition

Tropical sprue is a condition seen in residents of, or visitors to tropical areas. It impairs the absorption of nutrients from the intestines, causing malabsorption.

See also: Celiac disease - sprue

Causes, incidence, and risk factors

The cause of this disease is swelling (inflammation) of the small intestine due to excess levels of certain types of bacteria in the intestines.

Risk factors are:

• Living in the tropics
• Long periods of travel to tropical destinations

Symptoms

• Abdominal cramps
• Diarrhea, worse on high-fat diet
• Excessive gas (flatus)
• Indigestion
• Irritability
• Muscle cramps
• Numbness
• Paleness
• Weight loss

Signs and tests

• Complete blood count (CBC)
• Comprehensive metabolic panel
• Enteroscopy
• Folate level (serum)
• Iron level (serum)
• Stool examination for bacteria and parasites
• Upper endoscopy
• Upper GI series
• Vitamin B12 level (serum)

Treatment

Treatment begins with plenty of fluids and electrolytes. Replacement of folate, iron, vitamin B12, and other nutrients may also be needed. Antibiotic therapy with tetracycline or another broad-spectrum antibiotic is given at the beginning of treatment.

Oral tetracycline is usually not prescribed for children until after all of their permanent teeth have appeared, because it can permanently discolor teeth that are still forming.

Expectations (prognosis)

The outcome is good with treatment.

Complications

Vitamin and mineral deficiencies are common complications.

In children, sprue leads to:

• Delay in the maturing of bones (skeletal maturation)
• Growth failure

Calling your health care provider

Call your health care provider if:

• Tropical sprue symptoms get worse or do not improve with treatment
• You develop new symptoms
• You have diarrhea or other symptoms of this disorder for a long period of time, especially after spending time in the tropics

Prevention

Other than avoiding living in or traveling to tropical climates, there is no known prevention for tropical sprue.

References

Semrad CE, Powell DW. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 143.

Answer 2

Definition

Tropical sprue is a condition seen in residents of, or visitors to, tropical areas. It impairs the absorption of nutrients from the intestines, causing malabsorption.

See also: Celiac disease - sprue

Causes, incidence, and risk factors

The cause of this disease is swelling (inflammation) of the small intestine due to excess levels of certain types of bacteria in the intestines.

Risk factors are:

• Living in the tropics
• Long periods of travel to tropical destinations

Symptoms

• Abdominal cramps
• Diarrhea, worse on high-fat diet
• Excessive gas (flatus)
• Indigestion
• Irritability
• Muscle cramps
• Numbness
• Paleness
• Weight loss

Signs and tests

• Complete blood count (CBC)
• Comprehensive metabolic panel
• Enteroscopy
• Folate level (serum)
• Iron level (serum)
• Stool examination for bacteria and parasites
• Upper endoscopy
• Upper GI series
• Vitamin B12 level (serum)

Treatment

Treatment begins with plenty of fluids and electrolytes. Replacement of folate, iron, vitamin B12, and other nutrients may also be needed. Antibiotic therapy with tetracycline or another broad-spectrum antibiotic is given at the beginning of treatment.

Oral tetracycline is usually not prescribed for children until after all of their permanent teeth have appeared, because it can permanently discolor teeth that are still forming.

Expectations (prognosis)

The outcome is good with treatment.

Complications

Vitamin and mineral deficiencies are common complications.

In children, sprue leads to:

• Delay in the maturing of bones (skeletal maturation)
• Growth failure

Calling your health care provider

Call your health care provider if:

• Tropical sprue symptoms get worse or do not improve with treatment
• You develop new symptoms
• You have diarrhea or other symptoms of this disorder for a long period of time, especially after spending time in the tropics

Prevention

Other than avoiding living in or traveling to tropical climates, there is no known prevention for tropical sprue.

References

Semrad CE, Powell DW. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 143.

Reviewed By

Review Date: 01/20/2010

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.