- J Thomas Lamont, MD
J Thomas Lamont, MD
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — Anorectal Disorders and Misc. Lower GI Disease
- Section Editor — Nutrition, Malabsorption, and Misc. Upper GI Disease
- Professor of Medicine
- Harvard Medical School
Tropical sprue is a chronic diarrheal disease, possibly of infectious origin, that involves the small intestine and is characterized by malabsorption of nutrients, especially folic acid and vitamin B12. Sprue is an Anglicized form of the Dutch word "sprouw,” a term applied in 1669 to a chronic diarrheal disease of unknown etiology accompanied by aphthous ulcers that was prevalent in Belgium . The designation tropical sprue was coined in 1880 by Sir Patrick Manson, an English tropical disease expert working in China .
Tropical sprue occurs in the tropics in a narrow band north and south of the equator to 30° latitude; however, the disease does not occur in all countries within this band . In the Western hemisphere, tropical sprue is particularly prevalent in Haiti, the Dominican Republic, Puerto Rico, and Cuba, but is rare or absent in Jamaica and the Bahamas. Tropical sprue is also common in India and to a lesser degree in Burma, Indonesia, Borneo, Malaysia, Singapore, and Vietnam, but is uncommon in Africa, China, and the Middle East . Only rare cases of tropical sprue have been reported in the United States.
The disease affects indigenous populations as well as visitors to the tropics who stay for more than a month. Tropical sprue is seldom seen in travelers who visit an endemic area for less than two weeks.
Although accurate data are not available, the incidence of tropical sprue appears to be declining. In India, the incidence of tropical sprue is decreasing, and Crohn disease and celiac disease are becoming the more common causes of malabsorption [5,6]. This decline in incidence is likely due to improved public hygiene, the widespread use of antibiotics, and more accurate serologic tests for celiac disease, which can mimic tropical sprue in its presentation and pathology.
A number of observations support the hypothesis that tropical sprue is an infectious disease [3,7-9]:
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