Tropical sprue pathophysiology: Difference between revisions

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**Reduced gut defense mechanisms resulting in increased bacterial over growth damages the [[enterocytes]] and crypt cells to cause intestinal [[Villous folds|villous]] atrophy. This causes chronic [[diarrhea]].
**Reduced gut defense mechanisms resulting in increased bacterial over growth damages the [[enterocytes]] and crypt cells to cause intestinal [[Villous folds|villous]] atrophy. This causes chronic [[diarrhea]].
**[[Bile acid]] deconjugation affects the [[Enterohepatic circulation|enterohepatic]] circulation and causes [[steatorrhea]].
**[[Bile acid]] deconjugation affects the [[Enterohepatic circulation|enterohepatic]] circulation and causes [[steatorrhea]].
**Vitamin B12 deficiency can occur if the ileum is involved and the megaloblastic change in the intestinal mucuosal epithelium results in the formation of dysfunctional epithelial cells.
**[[Vitamin B12 deficiency]] can occur if the [[ileum]] is involved and the [[Megaloblastic Anemias|megaloblastic]] change in the intestinal musocal [[epithelium]] results in the formation of dysfunctional [[epithelial]] cells.
**Slow mouth to [[cecum]] transit due to intestinal stasis promotes small intestinal bacterial over growth and patients with [[tropical sprue]] have higher levels of [[enteroglucagon]], [[peptide YY]], and [[neurotensin]] which decrease the [[motility]] of [[intestine]] all these can predispose to the development of [[tropical sprue]].<ref name="pmid12702046">{{cite journal| author=Ghoshal UC, Ghoshal U, Ayyagari A, Ranjan P, Krishnani N, Misra A et al.| title=Tropical sprue is associated with contamination of small bowel with aerobic bacteria and reversible prolongation of orocecal transit time. | journal=J Gastroenterol Hepatol | year= 2003 | volume= 18 | issue= 5 | pages= 540-7 | pmid=12702046 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12702046  }} </ref>
**Slow mouth to [[cecum]] transit due to intestinal stasis promotes small intestinal bacterial over growth and patients with [[tropical sprue]] have higher levels of [[enteroglucagon]], [[peptide YY]], and [[neurotensin]] which decrease the [[motility]] of [[intestine]] all these can predispose to the development of [[tropical sprue]].<ref name="pmid12702046">{{cite journal| author=Ghoshal UC, Ghoshal U, Ayyagari A, Ranjan P, Krishnani N, Misra A et al.| title=Tropical sprue is associated with contamination of small bowel with aerobic bacteria and reversible prolongation of orocecal transit time. | journal=J Gastroenterol Hepatol | year= 2003 | volume= 18 | issue= 5 | pages= 540-7 | pmid=12702046 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12702046  }} </ref>
**Mucosal [[disaccharidase]] deficiency is also a potential cause as patients with [[tropical sprue]] have higher levels of urinary lactuose excretion suggesting a deficiency of [[lactase]] enzyme.
**Mucosal [[disaccharidase]] deficiency is also a potential cause as patients with [[tropical sprue]] have higher levels of urinary lactuose excretion suggesting a deficiency of [[lactase]] enzyme.

Revision as of 15:35, 14 April 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

The exact pathophysiology of tropical sprue is unclear but is thought to be related to intestinal inflammation following an episode of diarrhea. The inflammation damages the intestinal villi and also result in lymphocytosis in the intestinal wall. Deficiency of lactase enzyme in results in malabsorption of carbohydrates and the dysfunctional enterocytes cause steatorrhea.

Pathophysiology

Pathogenesis

Pathogenesis of tropical sprue is unclear and multiple theories are proposed.The pathogenesis of tropical sprue includes:[1]

Genetics

People with Aw-19 HLA haplotype are at higher risk of developing tropical sprue.

Microscopic Pathology

Associated Conditons

There are no associated conditions with tropical sprue.

References

  1. Ghoshal UC, Kumar S, Misra A, Choudhuri G (2013). "Pathogenesis of tropical sprue: a pilot study of antroduodenal manometry, duodenocaecal transit time & fat-induced ileal brake". Indian J Med Res. 137 (1): 63–72. PMC 3657900. PMID 23481053.
  2. Brown, Ian S.; Bettington, Andrew; Bettington, Mark; Rosty, Christophe (2014). "Tropical Sprue". The American Journal of Surgical Pathology. 38 (5): 666–672. doi:10.1097/PAS.0000000000000153. ISSN 0147-5185.
  3. Ghoshal UC, Ghoshal U, Ayyagari A, Ranjan P, Krishnani N, Misra A; et al. (2003). "Tropical sprue is associated with contamination of small bowel with aerobic bacteria and reversible prolongation of orocecal transit time". J Gastroenterol Hepatol. 18 (5): 540–7. PMID 12702046.
  4. SWANSON VL, THOMASSEN RW (1965). "PATHOLOGY OF THE JEJUNAL MUCOSA IN TROPICAL SPRUE". Am J Pathol. 46: 511–51. PMC 1920377. PMID 14278662.

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