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Tropical Sprue

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Tropical Sprue

para>Do not treat pediatric patients with tetracycline.

Admission Criteria/Initial Stabilization

No restrictions, as tolerated

As needed for symptoms

No special diet (gluten-free diets do not have an effect on this disease); restriction of long-chain fatty acids may improve steatorrhea.

11 Ghoshal UC, Srivastava D, Verma A, et al. Tropical sprue in 2014: the new face of an old disease. Curr Gastroenterol Rep. 2014;16(6):391.22 Ranjan P, Ghoshal UC, Aggarwal R, et al. Etiological spectrum of sporadic malabsorption syndrome in northern Indian adults at a tertiary hospital. Indian J Gastroenterol. 2004;23(3):94 " 98.33 Klipstein FA, Holdeman LV, Corcino JJ, et al. Enterotoxigenic intestinal bacteria in tropical sprue. Ann Intern Med. 1973;79(5):632 " 641.44 Gorbach SL. Microflora of the gastrointestinal tract in tropical enteritis: a current appraisal. Am J Clin Nutr. 1972;25(10):1127 " 1133.55 Ramakrishna BS, Venkataraman S, Mukhopadhya A. Tropical malabsorption. Postgrad Med J. 2006;82(974):779 " 787.66 Ghoshal UC, Ghoshal U, Ayyagari A, et al. Tropical sprue is associated with contamination of small bowel with aerobic bacteria and reversible prolongation of orocecal transit time. J Gastroenterol Hepatol. 2003;18(5):540 " 547.77 Cook GC. Aetiology and pathogenesis of postinfective tropical malabsorption (tropical sprue). Lancet. 1984;1(8379):721 " 723.88 Banwell JG, Gorbach SL. Tropical sprue. Gut. 1969;10(5):328 " 333.99 Shah VH, Rotterdam H, Kotler DP, et al. All that scallops is not celiac disease. Gastrointest Endosc. 2000;51(6):717 " 720.1010 Jeejeebhoy KN, Pathare SM, Noronha JM. Observations on conjugated and unconjugated blood folate levels in megaloblastic anemia and the effects of vitamin B12. Blood. 1965;26:354 " 359.1111 Sheehy TW, Rubini ME, Perez-Santiago E, et al. The effect of "minute " and "titrated " amounts of folic acid on the megaloblastic anemia of tropical sprue. Blood. 1961;18:623 " 636.1212 Rickles FR, Klipstein FA, Tomasini J, et al. Long-term follow-up of antibiotic-treated tropical sprue. Ann Intern Med. 1972;76(2):203 " 210.1313 Horta EO, Maldonado N, Fradera J, et al. Response of tropical sprue to poorly absorbed sulfonamides and oxytetracycline. Am J Clin Nutr. 1971;24(11):1327 " 1336.

Do not treat with tetracycline during pregnancy.

INPATIENT CONSIDERATIONS

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

DIET

PROGNOSIS

  • Good with appropriate treatment
  • Signs of improvement include less diarrhea, increase in hemoglobin levels, and return of normal small intestinal histology.
  • Recurrences do happen in native residents treated in the tropics.

COMPLICATIONS

  • Malabsorption: Small intestine permeability does not change after successful treatment.
  • Relapse is possible if medication regimen is stopped too soon.

REFERENCES

ADDITIONAL READING

  • Lo ‚ A, Guelrud ‚ M, Essenfeld ‚ H, et al. Classification of villous atrophy with enhanced magnification endoscopy in patients with celiac disease and tropical sprue. Gastrointest Endosc. 2007;66(2):377 " “382.
  • Westergaard ‚ H. Tropical sprue. Curr Treat Options Gastroenterol. 2004;7(1):7 " “11.

SEE ALSO

  • Celiac Disease; Diarrhea, Chronic
  • Algorithm: Diarrhea, Chronic

CODES

ICD10

ICD9

SNOMED

CLINICAL PEARLS

  • Tropical sprue is endemic in certain geographic areas.
  • Unless treated, symptoms persist or recur.
  • Gluten-free diet does not alter symptoms of tropical sprue.