Tropical sprue
Tropical sprue is a condition that occurs in people who live in or visit tropical areas for extended periods of time. It impairs nutrients from being absorbed from the intestines.
Tropical sprue (TS) is a syndrome characterized by acute or chronic diarrhea, weight loss, and malabsorption of nutrients.
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.
Causes
This disease is caused by damage to the lining of the small intestine. It comes from having too much of certain types of bacteria in the intestines.
Risk factors are:
- Living in the tropics
- Long periods of travel to tropical destinations
Symptoms
Symptoms include:
- Abdominal cramps
- Diarrhea, worse on a high-fat diet
- Excess gas (flatus)
- Fatigue
- Fever
- Leg swelling
- Weight loss
Symptoms may not appear for up to 10 years after leaving the tropics.
Exams and Tests
There is no clear marker or test that clearly diagnoses this problem.
Certain tests help to confirm that poor absorption of nutrients is present:
- D-xylose is a lab test to see how well the intestines absorb a simple sugar
- Tests of the stool to see if fat is absorbed correctly
- Blood tests to measure iron, folate, vitamin B12, or vitamin D
- Complete blood count (CBC)
Tests that examine the small intestine may include:
- Enteroscopy
- Upper endoscopy
- Biopsy of the small intestine
- Upper GI series
Treatment
Treatment begins with plenty of fluids and electrolytes. Replacement of folate, iron, vitamin B12, and other nutrients may also be needed. Antibiotic therapy with tetracycline or Bactrim is typically given for 3 to 6 months.
In most cases, oral tetracycline is not prescribed for children until after all the permanent teeth have come in. This medicine can permanently discolor teeth that are still forming. However, other antibiotics can be used.
Outlook (Prognosis)
The outcome is good with treatment.
Possible Complications
Vitamin and mineral deficiencies are common.
In children, sprue leads to:
- Delay in the maturing of bones (skeletal maturation)
When to Contact a Medical Professional
Contact your health care provider if:
- Tropical sprue symptoms get worse or do not improve with treatment.
- You develop new symptoms.
- You have diarrhea or other symptoms of this disorder for a long period of time, especially after spending time in the tropics.
Prevention
Other than avoiding living in or traveling to tropical climates, there is no known prevention for tropical sprue.
References
Ramakrishna BS. Tropical diarrhea and malabsorption. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 108.
Semrad SE. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 131.
Version Info
Last reviewed on: 10/25/2021
Reviewed by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
