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==Overview==
==Overview==
[[Tropical sprue]] has an acute and a chronic phase and usually follows an episode of infectious [[diarrhea]]. The patients present with chronic non bloody [[diarrhea]] with [[malabsorption]]. The chronic phase can result in [[malabsorption]] and the patients will develop symptoms of [[vitamin B12]] and [[vitamin A deficiency]]. The prognosis is excellent with treatment.


==Natural History==
==Natural History, Complications and Prognosis==
* The clinical presentation depends on the duration of illness.
===Natural History===
* Some patients may have symptoms lasting for days to weeks while other have a chronic course with remissions and relapses for many years.
[[Tropical sprue]] is a diagnosis of exclusion, patients present with chronic non-bloody [[diarrhea]], abdominal [[bloating]] and [[flatulence]] following an episode of infectious [[diarrhea]]. Patients with chronic form of [[tropical sprue]] presents with features of [[Vitamin B12 Deficiency|vitamin B12]] and [[Vitamin A deficiency|vitamin A]] deficiencies. If left untreated it is associated with significant [[morbidity]] and [[mortality]], therefore suspicion of [[tropical sprue]] must be high if histology of the duodenal [[biopsy]] demonstrates [[Villous folds|villous]] atrophy and if the patient is unresponsive to a gluten free diet.<ref name="pmid12859716">{{cite journal| author=Walker MM| title=What is tropical sprue? | journal=J Gastroenterol Hepatol | year= 2003 | volume= 18 | issue= 8 | pages= 887-90 | pmid=12859716 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12859716 }} </ref>
* Malabsorption, may be seen as early as week after the onset of symptoms but manifestations of specific vitamin deficiencies may take longer.
* With no treatment, mortality in an epidemic reaches 30%.<ref name="pmid5675861">{{cite journal| author=Baker SJ, Mathan VI| title=Syndrome of tropical sprue in South India. | journal=Am J Clin Nutr | year= 1968 | volume= 21 | issue= 9 | pages= 984-93 | pmid=5675861 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5675861 }} </ref>
* During the early stages of the illness, the mortality is mainly related to the fluid and electrolyte imbalances.
* Later in the disease deaths are associated with anemia, hypoproteinemia and secondary infection.
* Among the patients who survive, there is a strong tendency to spontaneous recovery even without treatment.
 
==Complications==
Vitamin and mineral deficiencies are common complications due to continued fluid and electrolyte losses associated with diarrhea.
* Dehydration
* Hyponatremia
* Hypokalemia
* Hypomagnesemia
* Metabolic acidosis
 
In children, sprue leads to:


*Delay in the maturing of bones (skeletal maturation)
===Complications===
*Growth
The complications of [[tropical sprue]] include:<ref name="pmid24441659">{{cite journal| author=Brown IS, Bettington A, Bettington M, Rosty C| title=Tropical sprue: revisiting an underrecognized disease. | journal=Am J Surg Pathol | year= 2014 | volume= 38 | issue= 5 | pages= 666-72 | pmid=24441659 | doi=10.1097/PAS.0000000000000153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24441659  }} </ref>
*[[Vitamin B12]] deficiency causes sub acute combined degeneration of the [[spinal cord]] resulting in neurological symptoms.
*[[Vitamin A deficiency]] causes visual disturbances and night blindness.
*[[Hypokalemia]] can occur due to chronic [[diarrhea]].


==Prognosis==
===Prognosis===
The prognosis for tropical sprue is excellent. It usually does not recur in patients who get it during travel to affected regionsThe recurrence rate for natives is about 20%.
All the patients with [[tropical sprue]] have excellent prognosis with [[tetracycline]] treatment. Treatment is continued for a period of 6 months but the symptoms resolve within 2 to 3 weeks from initiation of therapy.<ref name="pmid5009590">{{cite journal| author=Rickles FR, Klipstein FA, Tomasini J, Corcino JJ, Maldonado N| title=Long-term follow-up of antibiotic-treated tropical sprue. | journal=Ann Intern Med | year= 1972 | volume= 76 | issue= 2 | pages= 203-10 | pmid=5009590 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5009590 }} </ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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[[Category:Gastroenterology]]


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Latest revision as of 18:39, 22 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]

Overview

Tropical sprue has an acute and a chronic phase and usually follows an episode of infectious diarrhea. The patients present with chronic non bloody diarrhea with malabsorption. The chronic phase can result in malabsorption and the patients will develop symptoms of vitamin B12 and vitamin A deficiency. The prognosis is excellent with treatment.

Natural History, Complications and Prognosis

Natural History

Tropical sprue is a diagnosis of exclusion, patients present with chronic non-bloody diarrhea, abdominal bloating and flatulence following an episode of infectious diarrhea. Patients with chronic form of tropical sprue presents with features of vitamin B12 and vitamin A deficiencies. If left untreated it is associated with significant morbidity and mortality, therefore suspicion of tropical sprue must be high if histology of the duodenal biopsy demonstrates villous atrophy and if the patient is unresponsive to a gluten free diet.[1]

Complications

The complications of tropical sprue include:[2]

Prognosis

All the patients with tropical sprue have excellent prognosis with tetracycline treatment. Treatment is continued for a period of 6 months but the symptoms resolve within 2 to 3 weeks from initiation of therapy.[3]

References

  1. Walker MM (2003). "What is tropical sprue?". J Gastroenterol Hepatol. 18 (8): 887–90. PMID 12859716.
  2. Brown IS, Bettington A, Bettington M, Rosty C (2014). "Tropical sprue: revisiting an underrecognized disease". Am J Surg Pathol. 38 (5): 666–72. doi:10.1097/PAS.0000000000000153. PMID 24441659.
  3. Rickles FR, Klipstein FA, Tomasini J, Corcino JJ, Maldonado N (1972). "Long-term follow-up of antibiotic-treated tropical sprue". Ann Intern Med. 76 (2): 203–10. PMID 5009590.


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