Definition

Tropical sprue is a malabsorption syndrome of unknown cause that is common in the tropics and subtropics.

Causes, incidence, and risk factors

The cause of this disease is unknown, but it may be related to an infectious organism. The condition affects residents of or visitors to the tropics. The main symptom is diarrhea, which may get better after leaving tropical areas, but may reappear years later. Risk factors are living in the tropics or long travel to tropical destinations.

Symptoms

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

In children, sprue most often presents with growth failure and delayed skeletal maturation.

Signs and tests

• Small bowel biopsy showing findings of tropical sprue (including malabsorption or infection)
• Upper endoscopy and upper GI series are sometimes helpful in the diagnosis
• CBC showing anemia
• Stool showing increased fecal fat
• CHEM 20 showing low amounts of serum calcium, albumin, serum phosphorus, and serum cholesterol

Treatment

Treatment begins with rehydration with fluids and electrolytes. Replacement of folate, iron, vitamin B12, and other nutrients may also be needed. Antibiotic therapy with tetracycline is given at the beginning of treatment.

Oral tetracycline is usually not prescribed for children until after all permanent teeth have erupted. It can permanently discolor teeth that are still forming.

Support Groups

Expectations (prognosis)

The outcome is expected to be good with treatment.

Complications

Vitamin and mineral deficiencies are common complications.

Calling your health care provider

Call your provider if you experience prolonged diarrhea or other symptoms of this disorder, especially after spending time in the tropics.

Call your provider if tropical sprue symptoms worsen or do not improve with treatment, or if new symptoms develop.

Prevention

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

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