Tropical sprue pathophysiology: Difference between revisions
Jump to navigation
Jump to search
| Line 25: | Line 25: | ||
===Microscopic Pathology=== | ===Microscopic Pathology=== | ||
*Small bowel biospy reveals similar changes as gluten sensitive enteropathy. | *Small bowel biospy reveals similar changes as gluten sensitive enteropathy. | ||
*The features demonstrated on a duodenal biopsy include : | *The features demonstrated on a duodenal biopsy include :<ref name="pmid14278662">{{cite journal| author=SWANSON VL, THOMASSEN RW| title=PATHOLOGY OF THE JEJUNAL MUCOSA IN TROPICAL SPRUE. | journal=Am J Pathol | year= 1965 | volume= 46 | issue= | pages= 511-51 | pmid=14278662 | doi= | pmc=1920377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14278662 }} </ref> | ||
**Incomplete villous blunting | **Incomplete villous blunting | ||
**Intra epithelial lymphocytosis | **Intra epithelial lymphocytosis | ||
Revision as of 17:24, 11 April 2017
|
Tropical sprue Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Tropical sprue pathophysiology On the Web |
|
American Roentgen Ray Society Images of Tropical sprue pathophysiology |
|
Risk calculators and risk factors for Tropical sprue pathophysiology |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Pathophysiology
Pathogenesis
Pathogenesis of tropical sprue is unclear and multiple theories are proposed.The factors involved in the pathogenesis of tropical sprue include:[1]
- Small intestinal bacterial overgrowth affects the enterocyte brush border activity. Bacteria also affect the duodenal morphology causing villous atrophy and increased number of lymphocytes in the intestinal cells.
- Impaired host immune response resulting in prolonged inflammation of the small bowel
- Reduced gut defense mechanisms resulting in increased bacterial over growth damages the enterocytes and crypt cells to induce a inflammatory process.
- Intestinal villous atrophy
- Bile acid deconjugation affects the enterohepatic circulation and cause steatorrhea.
- Vitamin B12 deficiency causing megaloblastic change in the intestinal mucuosal epithelium
- Slow mouth to ceacum transit due to intestinal stasis promotes small intestinal bacterial over growth. Patients with tropical sprue have higher levels of enteroglucagon, peptide YY, and neurotensin which decrease the motility of intestine.
- Mucosal disaccharidase deficiency : Patients with tropical sprue have higher levels of urinary lactulose excretion suggesting a deficiency of lactase enzyme.
- Post infectious diarrhea: This theory is supported by the occurrence of the disease following an episode of acute gastroenteritis, occurrence of the disease in epidemics in rural areas with poor sanitation, susceptibility of visitors from developed countries to endemic regions and the frequency of small bowel bacterial overgrowth in patients with tropical spr
Genetics
People with HLA HLA haplotypes, especially the Aw-19 series are at higher risk of developing tropical sprue.
Gross Pathology
Microscopic Pathology
- Small bowel biospy reveals similar changes as gluten sensitive enteropathy.
- The features demonstrated on a duodenal biopsy include :[2]
- Incomplete villous blunting
- Intra epithelial lymphocytosis
- Eosinophilic infilteration of the mucosa
Associated Conditons
References
- ↑ 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.
- ↑ SWANSON VL, THOMASSEN RW (1965). "PATHOLOGY OF THE JEJUNAL MUCOSA IN TROPICAL SPRUE". Am J Pathol. 46: 511–51. PMC 1920377. PMID 14278662.