What is tropical sprue?

Abstract

A simple definition of tropical sprue (TS) is 'an acquired disease of unknown etiology characterized by malabsorption, multiple nutritional deficiencies, and mucosal abnormalities in the small bowel'. 1 There are few recent studies on this entity and considerable confusion regarding the relationship of TS to tropical enteropathy and traveller's diarrhea. In issue 5 of the Journal, Ghoshal et al. 2 define a group of patients with TS by strict clinical and pathological criteria and show that aerobic bacteria contaminate the small bowel in patients with TS and that these patients have a prolonged orocecal transit time (OCTT) compared with healthy control subjects. It is speculated that bacterial contamination worsens steatorrhea and activates the 'ileal brake', which is reversible in the majority of patients on treatment with tetracycline and folic acid. The etiology of TS is presumed to be infective; however, attempts have failed to isolate a single organism and it might therefore be the result of an unfortunate coincidence of circumstances. Most likely 'hit and run' bacteria damage enterocytes, resulting in a cascade of events leading to small bowel stasis, bacterial overgrowth, disturbances in gut motility, malabsorption and loss of folate with further damage to the enterocyte, and a vicious cycle results. Elimination of bacterial overgrowth by tetracycline and mucosal repair by folate supplements results in the restoration of mucosal integrity. 3 The overlap of tropical enteropathy and TS corresponds to the particular geographical distribution of these conditions and a link is purely speculative. More studies are needed to unravel the nature of the enterocyte response in this spectrum of enteropathies resulting from antigen or pathogen insult. PATHOGENESIS OF TROPICAL SPRUEAlthough the pathogenesis of TS is unknown, speculation has centered around infection leading to bacterial overgrowth and disturbance of motility, but other factors such as genetic susceptibility, local environment, bacteria and food practices should be considered in the etiology.

H. Pylori Associated Spruelike Duodenitis Presenting with Chronic Diarrhea, Hypoalbuminemia and Edema ? A Case Report

“…A small, but significant group of patients can however present with symptoms similar to celiac disease such as chronic diarrhea and nutritional deficiency anemia with some of them showing duodenal intraepithelial lymphocytosis [3,5,10]. Detection of H.pylori in patients with Vitamin B12 deficiency and correction of the same after H.pylori eradication has prompted few authors to suggest a causal relationship between H.pylori and Vitamin B12 deficiency [11]. We noticed a similar therapeutic response in the present case.…”

Classification of Malabsorption Syndromes

“…The histological intestinal lesions are characterized by shortness of intestinal villi, crypt hyperplasia, large lymphomonocytary infiltration in the lamina propria, enterocytes with a cuboid or pseudostratified aspect. The clinical picture in the most severe cases can be similar to that of celiac disease [49] .…”

Femenina de 52 años con insuficiencia Renal Crónica y Esprue Tropical

“…Su mecanismo fisiopatológico involucra una alteración en la desconjugación y deshidroxilación de los ácidos biliares llevando a una disminución del ácido desoxicólico ileal y sobrecrecimiento bacteriano que condiciona niveles altos de ácido ursodesoxicólico que ocasiona la diarrea (1,2) . En la práctica diaria se encuentra que pueden existir otros condicionantes de enfermedad diarreica en los pacientes que cursan con IRC, tales como las infecciones bacterianas, virales y parasitarias; fármacos, las enfermedades sistémicas concomitantes o bien patologías primarias en la mucosa intestinal.…”