Current Tropical Medicine Reports

, Volume 5, Issue 3, pp 211–216 | Cite as

Nutritional Approach in Tropical Sprue Patients

  • Stefanie Knebusch TorielloEmail author
Metabolism in Tropical Health (K Schlosser, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Metabolism in Tropical Health


Purpose of Review

Tropical sprue (TS) is known to be a common malabsorption syndrome in tropical countries. The objective of the present review is to determine whether if there is new evidence for a specific nutritional approach for TS, since the management remains the same from several years ago and the treatment can also be confounded by other conditions such as celiac disease, tropical enteropathy, and parasitic infections.

Recent Findings

Tropical sprue accounts for a large proportion of cases of malabsorption in South Asia. Since tropical sprue requires a specific test for its diagnosis, it could have been mistaken with other conditions. However, epidemics of tropical sprue have not been reported.


TS has been thought to be uncommon in the last decades. Still, more studies are needed to determine whether if TS is uncommon in tropical countries or has been undiagnosed since TS can overlap between other malabsorption syndromes or celiac disease. However, to better understand about tropical sprue, more research is needed, focused on epidemiology, etiology, differential diagnosis and treatment, and nutritional approaches.


Tropical sprue Nutritional approach Malabsorption syndrome Folic acid 


Compliance with Ethics Guidelines

Conflict of Interest

Stefanie Knebusch Toriello declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    • Pipaliya N, Ingle M, Rathi C, Poddar P, Pandav N, Sawant P. Spectrum of chronic small bowel diarrhea with malabsorption in Indian subcontinent: is the trend really changing? Intest Res. 2016;14(1):75–82. Actual review of malabsorption in India, showing presence of TS. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    •• Ghoshal U, Srivastava D, Verma A, Ghoshal U. Tropical sprue in 2014: the new face of an old disease. Current Gastroenterology Reports. 2014;16(6):391. Review of tropical sprue with new information.
  3. 3.
    Murray J, Rubio-Tapia A. Diarrhoea due to small bowel diseases. Best Pract Res Clin Gastroenterol. 2012;26(5):581–600. Scholar
  4. 4.
    •• Ramakrishna B. Tropical diarrhea and malabsorption. In: Sleisenger M, Fordtran J, Feldman M, Brandt L, Friedman L, editors. Sleisenger and Fordtran’s gastrointestinal and liver disease. 10th ed. Philadelphia: Elsevier; 2016. Review of tropical sprue. Google Scholar
  5. 5.
    Langenberg M, Wismans P, van Genderen P. Distinguishing tropical sprue from celiac disease in returning travellers with chronic diarrhoea: a diagnostic challenge? Travel Med Infect Dis. 2014;12(4):401–5. Scholar
  6. 6.
    Klipstein F. Regarding the definition of tropical sprue. Gastroenterology. 1970;58(5):717–21.Google Scholar
  7. 7.
    Bartholomew C. William Hillary and sprue in the Caribbean: 230 years later. Gut. 1989;30:17–21.Google Scholar
  8. 8.
    Manson P. Notes on sprue. In: China, imperial maritime customs, special series no 2, medical reports for the half year ended 31 March 1880. Shanghai: Statistical Department of the Inspectorate General. 1880:33–7.Google Scholar
  9. 9.
    • Ramakrishna B, Venkataraman S, Mukhopadhya A. Tropical malabsorption. Postgrad Med J. 2006;82(974):779–87. Tropical malabsorption information. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Mathan M, Mathan V, Baker S. An electron-microscopic study of jejunal mucosal morphology in control. Subjects and in patients with tropical sprue in southern India. Gastroenterology. 1975;68(1):17–32.Google Scholar
  11. 11.
    Dutta AK, Balekuduru A, Chacko A. Spectrum of malabsorption in India – tropical sprue is still the leader. J Assoc Physicians India. 2011;59:420–422.Google Scholar
  12. 12.
    Yadav P, Das P, Mirdha B, Gupta S, Bhatnagar S, Pandey R, et al. Current spectrum of malabsorption syndrome in adults in India. Indian J Gastroenterol. 2011;30(1):22–8. Scholar
  13. 13.
    • Alvarez JJ, Zaga-Galante J, Vergara-Suarez A, Randall CW. Tropical sprue. J Trop Dis. 2014;02(01) Review of TS and treatment.
  14. 14.
    Ghoshal UC, Park H, Gwee KA. Bugs and irritable bowel syndrome: the good, the bad and the ugly. J Gastroenterol Hepatol. 2010;25(2):244–51. Scholar
  15. 15.
    Ghoshal UC, Ranjan P. Post-infectious irritable bowel syndrome: the past, the present and the future. J Gastroenterol Hepatol. 2011;26:94–101. Scholar
  16. 16.
    Greenson J. The biopsy pathology of non-coeliac enteropathy. Histopathology. 2015;66(1):29–36. Scholar
  17. 17.
    Walker M. What is tropical sprue? J Gastroenterol Hepatol. 2003;18(8):887–90. Scholar
  18. 18.
    •• Nath S. Tropical sprue. Current Gastroenterology Reports. 2005;7(5):343–9. Major importance review of tropical sprue.
  19. 19.
    Klipstein FA, Engert RF, Short HB. Enterotoxigenicity of colonising coliform bacteria in tropical sprue and blind-loop syndrome. Lancet. 1978;312(8085):342–4. Scholar
  20. 20.
    Bures J, Cyrany J, Kohoutova D, Förstl M, Rejchrt S, Kvetina J, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010;16(24):2978–90. Scholar
  21. 21.
    Bala L, Ghoshal U, Ghoshal U, Tripathi P, Misra A, Gowda G, et al. Malabsorption syndrome with and without small intestinal bacterial overgrowth: a study on upper-gut aspirate using1H NMR spectroscopy. Magn Reson Med. 2006;56(4):738–44. Scholar
  22. 22.
    Mathias J, Clench M. Review: pathophysiology of diarrhea caused by bacterial overgrowth of the small intestine. Am J Med Sci. 1985;289(6):243–8. Scholar
  23. 23.
    Carneiro F, Chaves P, Ensari A. Pathology of the gastrointestinal tract. Encyclopedia of Pathology of the gastrointestinal tract. Springer International Publishing; 2017.
  24. 24.
    van der Heide F. Acquired causes of intestinal malabsorption. Best Pract Res Clin Gastroenterol. 2016;30(2):213–24. Scholar
  25. 25.
    Jatol Batheja M, Leighton J, Azueta A, Heigh R. The face of tropical sprue in 2010. Case Report Gastroenterology. 2010;4:168–72. Scholar
  26. 26.
    Ramakrishna BS, Mathan VI. Water and electrolyte absorption by the colon in tropical sprue. Gut. 1982;23(10):843–6.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Ramakrishna B, Mathan V. Role of bacterial toxins, bile acids, and free fatty acids in colonic water malabsorption in tropical sprue. Dig Dis Sci. 1987;32(5):500–5. Scholar
  28. 28.
    Chidambaram Y, Mambatta A, Sivaraj S. Tropical sprue in megaloblastic anemia. J Res Med Sci. 2017;5(9):4133.Google Scholar
  29. 29.
    Saboor M, Zehra A, Qamar K. Disorders associated with malabsorption of iron; a critical review. Pak J Med Sci. 2016;31(6)
  30. 30.
    Perveen I, Hasan M, Kibria G, Rahman M. Tropical sprue (TS); experience in a tertiary care hospital. J Bangladesh Coll Phys Surg. 2011;29(1).
  31. 31.
    Louis-Auguste J, Kelly P. Tropical enteropathies. Current Gastroenterology Reports. 2017;19(7):29. Scholar
  32. 32.
    Duplessis C, Gutierrez R, Porter C. Review: chronic and persistent diarrhea with a focus in the returning traveler. Trop Dis Travel Med Vaccines. 2017;3(1):9. Scholar
  33. 33.
    Verna E. Use of probiotics in gastrointestinal disorders: what to recommend? Ther Adv Gastroenterol. 2010;3(5):307–19. Scholar
  34. 34.
    Brown I, Bettington A, Bettington M, Rosty C. Tropical Sprue. Am J Surg Pathol. 2014;38(5):666–72. Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Universidad Francisco MarroquínGuatemala CityGuatemala
  2. 2.Boston UniversityBostonUSA

Personalised recommendations