Tropical Sprue Follow-up

  • Author: Rohan C Clarke, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Jan 3, 2010
 

Further Inpatient Care

  • Patients with tropical sprue are not usually admitted as inpatients unless they present with at diagnosis of chronic diarrhea or malabsorption with dehydration and weight loss (see Medical Care).
  • Patients admitted with suspected tropical sprue should undergo workup and evaluation as previously described (see Workup).
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Further Outpatient Care

  • Observe patients regularly to ensure that they respond to treatment and that the correct diagnosis is made. The patient should be observed at least once a month with careful monitoring of lab studies to make sure that any signs or symptoms of malabsorption have been corrected.
  • Monitor weight gain.
  • Monitor the CBC count and electrolytes at least monthly.
  • Correct folate, vitamin B-12, and any other deficiencies.
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Inpatient & Outpatient Medications

  • The same medications are used in both outpatient and inpatient settings (see Medication).
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Deterrence/Prevention

  • No direct evidence indicates that antibiotic prophylaxis can prevent tropical sprue.
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Complications

  • Anemia
  • Malnutrition
  • Vitamin deficiency
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Prognosis

  • Prognosis of this condition is generally good.
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Patient Education

  • Travelers to the tropics should be aware of this syndrome and take steps to limit exposure to enteric pathogens. If protracted diarrhea occurs, early presentation to medical personnel is helpful.
  • For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center. Also, see eMedicine's patient education article Traveler's Diarrhea.
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Contributor Information and Disclosures
Author

Rohan C Clarke, MD  Consulting Staff, Department of Gastroenterology, JPS Health Systems Hospital

Rohan C Clarke, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society of Gastrointestinal Endoscopy

Disclosure: Salix Honoraria Round table feedback group

Coauthor(s)

Rachael M Ferraro, DO  Internal Medicine Hospitalist, Torrance Memorial Medical Center, Little Company of Mary Hospital

Rachael M Ferraro, DO is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Lisa Ozick, MD  Former Chief, Division of Gastroenterology, Harlem Hospital Center

Lisa Ozick, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and Phi Beta Kappa

Disclosure: Nothing to disclose.

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.

Specialty Editor Board

Manoop S Bhutani, MD  Professor, Co-Director, Center for Endoscopic Research, Training and Innovation (CERTAIN), Director, Center for Endoscopic Ultrasound, Department of Medicine, Division of Gastroenterology, University of Texas Medical Branch; Director, Endoscopic Research and Development, The University of Texas MD Anderson Cancer Center

Manoop S Bhutani, 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 Institute of Ultrasound in Medicine, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of 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

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 & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

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  2. Klipstein, FA. Tropical Sprue. Gastroenterology. 1968;54:275.

  3. Gorbach, SL, Banwell, JG, Jacobs, B, et al. Tropical Sprue and Malnutrition in West Bengal. I. Intestinal microflora and absorption. American Journal of Clinical Nutrition. 1970;23:1545.

  4. Klipstein, FA, Holdeman, LV, Corcino, JJ, et al. Enterotoxigenic intestinal bacteria in tropical sprue. Annals of Internal Medicine. 1973;79:632.

  5. Green PH, Shane E, Rotterdam H, Forde KA, Grossbard L. Significance of unsuspected celiac disease detected at endoscopy. Gastrointest Endosc. Jan 2000;51(1):60-5. [Medline].

  6. Ritchie BK, Brewster DR, Davidson GP, Tran CD, et al. 13C-sucrose breath test: novel use of a noninvasive biomarker of environmental gut health. Pediatrics. Aug 2009;124(2):620-6. [Medline].

  7. Lo A, Guelrud M, Essenfeld H, Bonis P. Classification of villous atrophy with enhanced magnification endoscopy in patients with celiac disease and tropical sprue. Gastrointest Endosc. Aug 2007;66(2):377-82. [Medline]. [Full Text].

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

  9. Dutta AK, Chacko A, Avinash B. Suboptimal performance of IgG anti-tissue transglutaminase in the diagnosis of celiac disease in a tropical country. Dig Dis Sci. Mar 31 2009;epub ahead of print. [Medline].

  10. Evans KE, Leeds JS, Sanders DS. Be vigilant for patients with coeliac disease. Practitioner. Oct 2009;253(1722):19-22, 2. [Medline].

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

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

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

  15. 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.

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

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

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

  19. Kuhlmann FM, Weil GJ. Infectious risks for travelers to the tropics. Mo Med. Jul-Aug 2009;106(4):263-8. [Medline].

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

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

  22. Toskes P. Malabsorption. In: Bennet JC, Plum F, eds. Cecil's Textbook of Medicine. 20th ed. Philadelphia, Pa: WB Saunders Co; 1996:705-6.

 
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Subtotal villous atrophy (H&E, orig. mag. ×10).
Tropical sprue (H&E, orig. mag. ×10).
Endoscopic views of unsuspected celiac disease. A: Absent duodenal folds. B: Mucosal fissures and scalloped folds. C: Scalloped fold.
 
 
 
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