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Nutritional Approach in Tropical Sprue Patients

  • Metabolism in Tropical Health (K Schlosser, Section Editor)
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Abstract

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.

Summary

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.

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References

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

  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. https://doi.org/10.5217/ir.2016.14.1.75. Actual review of malabsorption in India, showing presence of TS.

    Article  PubMed  PubMed Central  Google Scholar 

  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. https://doi.org/10.1007/s11894-014-0391-3. Review of tropical sprue with new information.

  3. Murray J, Rubio-Tapia A. Diarrhoea due to small bowel diseases. Best Pract Res Clin Gastroenterol. 2012;26(5):581–600. https://doi.org/10.1016/j.bpg.2012.11.013.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

  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. https://doi.org/10.1016/j.tmaid.2014.05.001.

    Article  PubMed  Google Scholar 

  6. Klipstein F. Regarding the definition of tropical sprue. Gastroenterology. 1970;58(5):717–21.

  7. Bartholomew C. William Hillary and sprue in the Caribbean: 230 years later. Gut. 1989;30:17–21.

  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.

  9. • Ramakrishna B, Venkataraman S, Mukhopadhya A. Tropical malabsorption. Postgrad Med J. 2006;82(974):779–87. https://doi.org/10.1136/pgmj.2006.048579. Tropical malabsorption information.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  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.

  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.

  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. https://doi.org/10.1007/s12664-011-0081-0.

    Article  PubMed  Google Scholar 

  13. • Alvarez JJ, Zaga-Galante J, Vergara-Suarez A, Randall CW. Tropical sprue. J Trop Dis. 2014;02(01) https://doi.org/10.4172/2329-891x.1000130. Review of TS and treatment.

  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. https://doi.org/10.1111/j.1440-1746.2009.06133.x.

    Article  PubMed  Google Scholar 

  15. Ghoshal UC, Ranjan P. Post-infectious irritable bowel syndrome: the past, the present and the future. J Gastroenterol Hepatol. 2011;26:94–101. https://doi.org/10.1111/j.1440-1746.2011.06643.x.

    Article  PubMed  Google Scholar 

  16. Greenson J. The biopsy pathology of non-coeliac enteropathy. Histopathology. 2015;66(1):29–36. https://doi.org/10.1111/his.12522.

    Article  PubMed  Google Scholar 

  17. Walker M. What is tropical sprue? J Gastroenterol Hepatol. 2003;18(8):887–90. https://doi.org/10.1046/j.1440-1746.2003.03127.x.

    Article  PubMed  Google Scholar 

  18. •• Nath S. Tropical sprue. Current Gastroenterology Reports. 2005;7(5):343–9. https://doi.org/10.1007/s11894-005-0002-4 Major importance review of tropical sprue.

  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. https://doi.org/10.1016/s0140-6736(78)92942-2.

    Article  Google Scholar 

  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. https://doi.org/10.3748/wjg.v16.i24.2978.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  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. https://doi.org/10.1002/mrm.21041.

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1097/00000441-198506000-00007.

    Article  PubMed  CAS  Google Scholar 

  23. Carneiro F, Chaves P, Ensari A. Pathology of the gastrointestinal tract. Encyclopedia of Pathology of the gastrointestinal tract. Springer International Publishing; 2017. https://doi.org/10.1007/978-3-319-40560-5.

  24. van der Heide F. Acquired causes of intestinal malabsorption. Best Pract Res Clin Gastroenterol. 2016;30(2):213–24. https://doi.org/10.1016/j.bpg.2016.03.001.

    Article  PubMed  CAS  Google Scholar 

  25. Jatol Batheja M, Leighton J, Azueta A, Heigh R. The face of tropical sprue in 2010. Case Report Gastroenterology. 2010;4:168–72. https://doi.org/10.1159/000314231.

    Article  Google Scholar 

  26. Ramakrishna BS, Mathan VI. Water and electrolyte absorption by the colon in tropical sprue. Gut. 1982;23(10):843–6.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  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. https://doi.org/10.1007/bf01296033.

    Article  PubMed  CAS  Google Scholar 

  28. Chidambaram Y, Mambatta A, Sivaraj S. Tropical sprue in megaloblastic anemia. J Res Med Sci. 2017;5(9):4133.

  29. Saboor M, Zehra A, Qamar K. Disorders associated with malabsorption of iron; a critical review. Pak J Med Sci. 2016;31(6) https://doi.org/10.12669/pjms.316.8125.

  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). https://doi.org/10.3329/jbcps.v29i1.7166.

  31. Louis-Auguste J, Kelly P. Tropical enteropathies. Current Gastroenterology Reports. 2017;19(7):29. https://doi.org/10.1007/s11894-017-0570-0.

    Article  PubMed  PubMed Central  Google Scholar 

  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. https://doi.org/10.1186/s40794-017-0052-2.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Verna E. Use of probiotics in gastrointestinal disorders: what to recommend? Ther Adv Gastroenterol. 2010;3(5):307–19. https://doi.org/10.1177/1756283X10373814.

    Article  Google Scholar 

  34. Brown I, Bettington A, Bettington M, Rosty C. Tropical Sprue. Am J Surg Pathol. 2014;38(5):666–72. https://doi.org/10.1097/pas.0000000000000153.

    Article  PubMed  Google Scholar 

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Correspondence to Stefanie Knebusch Toriello.

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

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This article is part of the Topical Collection on Metabolism in Tropical Health

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Knebusch Toriello, S. Nutritional Approach in Tropical Sprue Patients. Curr Trop Med Rep 5, 211–216 (2018). https://doi.org/10.1007/s40475-018-0159-1

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