- J Thomas Lamont, MD
J Thomas Lamont, MD
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — Anorectal Disorders and Misc. Lower GI Disease; 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]:
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: Sep 26, 2016.References
- Major RH. Classic description of disease, 3rd ed, Thomas CC (Ed), Springfield Hill, 1945. p.601.
- Manson P. Note on China imperial maritime custom. Medical Report 1980; 19:33.
- Gray GM. Tropical sprue. In: Infections of the Gastrointestinal Tract, Blaser MJ, Smith PD, Ravdin JI (Eds), Raven Press, New York 1995. p.333.
- Dutta AK, Balekuduru A, Chacko A. Spectrum of malabsorption in India--tropical sprue is still the leader. J Assoc Physicians India 2011; 59:420.
- Ramakrishna BS, Venkataraman S, Mukhopadhya A. Tropical malabsorption. Postgrad Med J 2006; 82:779.
- Thakur B, Mishra P, Desai N, et al. Profile of chronic small-bowel diarrhea in adults in Western India: a hospital-based study. Trop Gastroenterol 2006; 27:84.
- Klipstein FA. Tropical sprue. Gastroenterology 1968; 54:275.
- Gorbach SL, Banwell JG, Jacobs B, et al. Tropical sprue and malnutrition in West Bengal. I. Intestinal microflora and absorption. Am J Clin Nutr 1970; 23:1545.
- Klipstein FA, Holdeman LV, Corcino JJ, Moore WE. Enterotoxigenic intestinal bacteria in tropical sprue. Ann Intern Med 1973; 79:632.
- Bhat P, Shantakumari S, Rajan D, et al. Bacterial flora of the gastrointestinal tract in southern Indian control subjects and patients with tropical sprue. Gastroenterology 1972; 62:11.
- Ghoshal UC, Ghoshal U, Ayyagari A, et al. Tropical sprue is associated with contamination of small bowel with aerobic bacteria and reversible prolongation of orocecal transit time. J Gastroenterol Hepatol 2003; 18:540.
- Toskes PP. Chronic small intestinal infections. In: Gastrointestinal Infections, LaMont JT (Ed), Marcel Dekker, New York 1997. p.506.
- Ramakrishna BS, Mathan VI. Water and electrolyte absorption by the colon in tropical sprue. Gut 1982; 23:843.
- Misra RC, Kasthuri D, Chuttani HK. Correlation of clinical, biochemical, radiological, and histological findings in tropical sprue. J Trop Med Hyg 1967; 70:6.
- FLOCH MH, CALDWELL WL, SHEEHY TW. A histopathologic basis for the interpretation of small bowel roentgenography in tropical sprue. Am J Roentgenol Radium Ther Nucl Med 1962; 87:709.
- Ianiro G, Bibbò S, Montalto M, et al. Systematic review: Sprue-like enteropathy associated with olmesartan. Aliment Pharmacol Ther 2014; 40:16.
- Shah VH, Rotterdam H, Kotler DP, et al. All that scallops is not celiac disease. Gastrointest Endosc 2000; 51:717.
- SWANSON VL, THOMASSEN RW. PATHOLOGY OF THE JEJUNAL MUCOSA IN TROPICAL SPRUE. Am J Pathol 1965; 46:511.
- England NW, O'Brien W. Appearances of the jejunal mucosa in acute tropical sprue in Singapore. Gut 1966; 7:128.
- 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 2007; 66:377.
- Brown IS, Bettington A, Bettington M, Rosty C. Tropical sprue: revisiting an underrecognized disease. Am J Surg Pathol 2014; 38:666.
- Rickles FR, Klipstein FA, Tomasini J, et al. Long-term follow-up of antibiotic-treated tropical sprue. Ann Intern Med 1972; 76:203.
- SHEEHY TW, RUBINI ME, PEREZ-SANTIAGO E, et al. The effect of "minute" and "titrated" amounts of folic acid on the megaloblastic anemia of tropical sprue. Blood 1961; 18:623.
- JEEJEEBHOY KN, PATHARE SM, NORONHA JM. OBSERVATIONS ON CONJUGATED AND UNCONJUGATED BLOOD FOLATE LEVELS IN MEGALOBLASTIC ANEMIA AND THE EFFECTS OF VITAMIN B 12. Blood 1965; 26:354.
- Maldonado N, Horta E, Guerra R, Pérez-Santiago E. Poorly absorbed sulfonamides in the treatment of tropical sprue. Gastroenterology 1969; 57:559.