Highlights & Basics
- Tropical sprue should be considered in any patient with diarrhea and signs and/or symptoms of malabsorption who has spent more than 2 weeks in a tropical region where the disease is endemic.
- Improvement after folate replacement is prompt and dramatic. Failure to do so should elicit doubt about the diagnosis.
- No causative microbe has been found, but the condition is likely to result from bacterial infection.
- In addition to folic acid supplementation, long-term treatment with antibiotics is currently recommended.
- Deficiencies of folic acid and vitamin B12 and resultant megaloblastic anemia are the defining characteristics of the disease.
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Citations
Keele KD, Bound JP. Sprue in India: a clinical survey of 600 cases. BMJ. 1946;1:77-81.
Sheehy TW, Cohen WC, Wallace DK, et al. Tropical sprue in North Americans. JAMA. 1965;194:1069-1076.[Abstract]
Sheehy TW, Baggs B, Perez-Santiago E, et al. Prognosis of tropical sprue. A study of the effect of folic acid on the intestinal aspects of acute and chronic sprue. Ann Intern Med. 1962;57:892-908.[Abstract]
Suarez RM, Spies TD, Suarez RM Jr. The use of folic acid in sprue. Ann Intern Med. 1947;26:642-677.
Rickles FR, Klipstein FA, Tomasini J, et al. Long-term follow-up of antibiotic-treated tropical sprue. Ann Intern Med. 1972;76:203-210.[Abstract]
Guerra R, Wheby MS, Bayless TM. Long term antibiotic in tropical sprue. Ann Intern Med. 1965;63:619-634.[Abstract]
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3. Sheehy TW, Cohen WC, Wallace DK, et al. Tropical sprue in North Americans. JAMA. 1965;194:1069-1076.[Abstract]
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26. Sheehy TW, Floch MH. The small intestine - its function and diseases. New York: Harper & Row Publishers; 1964:74-76.
27. Corcino JJ, Reisenauer AM, Halsted CH. Jejunal perfusion of simple and conjugated folates in tropical sprue. J Clin Invest. 1976;58:298-305.[Abstract][Full Text]
28. Lindenbaum J. Small intestine dysfunction in Pakistanis and Americans resident in Pakistan. Am J Clin Nutr. 1968;21:1023-1029.[Abstract]
29. Gorbach SL, Mittra R, Jacobs B, et al. Bacterial contamination of the upper small bowel in tropical sprue. Lancet. 1969;1:74-77.[Abstract]
30. Lo A, Guelrud M, Essenfeld H, et al. Classification of villous atrophy with enhanced magnification endoscopy in patients with celiac disease and tropical sprue. Gastrointest Endosc. 2007;66:377-382.[Abstract]
31. Tomkins AM, Smith T, Wright SG. Assessment of early and delayed responses in vitamin B12 absorption during antibiotic therapy in tropical malabsorption. Clin Sci Mol Med Suppl. 1978;55:533-539.[Abstract]
32. Sheehy TW, Baggs B, Perez-Santiago E, et al. Prognosis of tropical sprue. A study of the effect of folic acid on the intestinal aspects of acute and chronic sprue. Ann Intern Med. 1962;57:892-908.[Abstract]
33. Suarez RM, Spies TD, Suarez RM Jr. The use of folic acid in sprue. Ann Intern Med. 1947;26:642-677.
34. Basson M, Mezzarobba M, Weill A, et al. Severe intestinal malabsorption associated with olmesartan: a French nationwide observational cohort study. Gut. 2015 Aug 6 [Epub ahead of print].[Abstract]
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37. Rickles FR, Klipstein FA, Tomasini J, et al. Long-term follow-up of antibiotic-treated tropical sprue. Ann Intern Med. 1972;76:203-210.[Abstract]
38. Guerra R, Wheby MS, Bayless TM. Long term antibiotic in tropical sprue. Ann Intern Med. 1965;63:619-634.[Abstract]
39. Ramakrishna BS, Venkataraman S, Mukhopadhya A. Tropical malabsorption. Postgrad Med J. 2006;82:779-787.[Abstract]
