Tropical sprue

As the name suggests, this disease is found in the tropics. Tropical sprue is a chronic, progressive, malabsorptive disorder. It is similar to coeliac disease in that villous atrophy is present but symptoms do not respond to a gluten-free diet. The epidemiological pattern and occasional epidemics suggest that an infective agent or agents may be involved. Although no single bacterium has been isolated, the condition often begins after an acute diarrhoeal illness. Diarrhoea, abdominal distension, anorexia, fatigue and weight loss are the most common symptoms. In visitors to the tropics the onset of severe diarrhoea may be sudden and accompanied by fever. Tropical sprue is treated with broad-spectrum antibiotics as small bowel overgrowth with E. coli, enterobacterium and Klebsiella are often seen. Resulting nutritional deficiences may be corrected with folic acid supplements.

Evidence-based guidelines for the management of a variety of malabsorptive disorders have been published by the British Society of Gastroenterology (BSG 2003).

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