eMedicine Specialties > Gastroenterology > Intestine

Sprue, Tropical: Differential Diagnoses & Workup

Author: Lisa Ozick, MD, Chief, Division of Gastroenterology, Harlem Hospital Center
Coauthor(s): Sabo B Tanimu, MD, Fellow, Department of Medicine, Division of Gastroenterology, Harlem Hospital Center; Oluyinka S Adediji, MD, Consulting Staff, Department of Adult and General Medicine, Health Services Incorporated, Montgomery, Alabama
Contributor Information and Disclosures

Updated: Mar 13, 2006

Differential Diagnoses

Scleroderma

Other Problems to Be Considered

General fat malabsorption

Bacterial overgrowth
Ileal diseases
Pancreatic disorders

Mucosal diseases leading to malabsorption

AIDS enteropathy
Celiac sprue
Cryptosporidia
Giardiasis
Infectious causes
Nonspecific enteropathy
Norwalk virus
Radiation enteropathy
Intestinal lymphoma

Workup

Laboratory Studies

  • Clinical presentation, including diarrhea, malabsorption of nutrients, and anemia workup, influences the extent of diagnostic tests. Findings of steatorrhea, mucosal malabsorption of 2 substances (eg, fat, D-xylose), and villous atrophy (demonstrated by means of biopsy) are adequate to make a diagnosis. Response to treatment is considered by some to be the conclusive evidence that confirms the diagnosis.
  • CBC count: This shows megaloblastic anemia associated with reduced folate and vitamin B-12 levels in as many as 60% of patients.
  • Blood chemistry test: This includes potassium, calcium, magnesium, phosphate, albumin, cholesterol, and iron studies.
  • Stool collection test
    • This measures fat content over 72 hours on a diet of 80-100 g of fat.
    • A result of more than 6 g in 24 hours is abnormal (positive for fat malabsorption). Fatty stools are usually observed when the stool fat content is 15 g or more.
  • D-Xylose absorption test
    • For this study, 25 g D-xylose is administered orally.
    • In well-hydrated patients with normal renal function, abnormal results (ie, positive for mucosal malabsorption) include a 5-hour urine collection of less than 4 g and a 1-hour serum collection of less than 20 mg/dL.

Imaging Studies

  • A barium swallow and follow-through may reveal increased caliber and thickening of mucosal folds or flocculation and segmentation of barium, depending on the type of barium used.

Procedures

  • Jejunal biopsy
    • Mild villous atrophy
    • Increased villous crypts and mononuclear cellular infiltrates, enlarged epithelial cells, and large nuclei caused by folate and/or vitamin B-12 deficiency
  • Characteristic accumulation of lipid beneath the basement membrane

Histologic Findings

See Pathophysiology.

More on Sprue, Tropical

Overview: Sprue, Tropical
Differential Diagnoses & Workup: Sprue, Tropical
Treatment & Medication: Sprue, Tropical
Follow-up: Sprue, Tropical
References
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References

  1. Cook GC. Aetiology and pathogenesis of postinfective tropical malabsorption (tropical sprue). Lancet. Mar 31 1984;1(8379):721-3. [Medline].

  2. Farthing MJ. Tropical malabsorption and tropical diarrhea. In: Feldman M, ed. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 6th ed. Philadelphia, Pa: WB Saunders Co; 1998:1574-1584.

  3. Floch MH, Ozick L. Tropical sprue. In: Hurst JW, ed. Medicine for the Practicing Physician. 3rd ed. Boston, Mass: Butterworth;1992:1547-1549.

  4. French AB. Tropical sprue--specific disease or extreme of a spectrum?. Ann Intern Med. Jun 1968;68(6):1362-5. [Medline].

  5. Gilman AG, ed. The Pharmacological Basis of Therapeutics. 8th ed. New York, NY:. Pergamon Press Inc;1990.

  6. Greeberger NJ, Isselbacher KJ. Disorders of absorption. In: Fauci AS, ed. Harrison's Principle of Internal Medicine. 14th ed. New York, NY: McGraw-Hill;1998:1626.

  7. Klipstein FA, Baker SJ. Regarding the definition of tropical sprue. Gastroenterology. May 1970;58(5):717-21. [Medline].

  8. Klipstein FA. Tropical sprue--an iceberg disease?. Ann Intern Med. Mar 1967;66(3):622-3. [Medline].

  9. Klipstein FA. Tropical sprue in travelers and expatriates living abroad. Gastroenterology. Mar 1981;80(3):590-600. [Medline].

  10. Nath SK. Tropical sprue. Curr Gastroenterol Rep. Oct 2005;7(5):343-9. [Medline].

  11. Thielman NM, Guerrant RL. Persistent diarrhea in the returned traveler. Infect Dis Clin North Am. Jun 1998;12(2):489-501. [Medline].

  12. Toskes P. Malabsorption. In: Bennet JC, Plum F, eds. Cecil Textbook of Medicine. Philadelphia, Pa:. WB Saunders Co;1996:705-706.

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Further Reading

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Keywords

tropical sprue, aphthoids chronica, diarrhea, cachectic diarrhea, psilosis, postinfective tropical malabsorption, TS, intestinal stasis, mucosal injury, ileal mucosa injury, mucosal malabsorption, intestinal malabsorption, malabsorption of nutrients, villous atrophy, enterocyte injury, intestinal stasis, jejunal mucosa injury, tropical diarrhea

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Contributor Information and Disclosures

Author

Lisa Ozick, MD, Chief, Division of Gastroenterology, Harlem Hospital Center
Lisa Ozick, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

Sabo B Tanimu, MD, Fellow, Department of Medicine, Division of Gastroenterology, Harlem Hospital Center
Disclosure: Nothing to disclose.

Oluyinka S Adediji, MD, Consulting Staff, Department of Adult and General Medicine, Health Services Incorporated, Montgomery, Alabama
Oluyinka S Adediji, MD is a member of the following medical societies: American College of Physicians and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Manoop S Bhutani, MD, FACG, FACP, Professor, Department of Medicine, Division of Gastroenterology, Director, Center for Endoscopic Ultrasound, Co-Director, Center for Endoscopic Research, Training and Innovation, University of Texas Medical Branch at Galveston
Manoop S Bhutani, MD, FACG, FACP is a member of the following medical societies: American Association for the Advancement of Science, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Institute of Ultrasound in Medicine, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Noel Williams, MD, Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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