Tropical Sprue

Disease Overview

Tropical Sprue is a rare digestive disease in which the small intestine’s ability to absorb nutrients is impaired (malabsorption). Consequently, nutritional deficiencies and abnormalities in the mucous lining of the small intestine may be present. The exact cause of this disorder is not known, however it may be related to environmental and nutritional conditions in the tropical regions where it is most prevalent.

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Synonyms

Hill Diarrhea
Tropical Diarrhea

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Signs & Symptoms

The symptoms of Tropical Sprue may include fatigue and diarrhea with stools that are abundant, pale and foul-smelling. People with this disorder may also experience a profound loss of appetite (anorexia), a sore tongue, night blindness, weight loss, a loss of strength and energy (asthenia) and general weakness.

The onset of Tropical Sprue may be sudden. Individuals may have an abnormally high fever, inflammation of the mouth and tongue, experience dry skin, a scaly appearance on the lips and at the angles of the mouth. Sometimes mental depression may occur.

For some people with Tropical Sprue, symptoms cease as suddenly as they may have begun (spontaneous remission). Treatment of the disorder in its early stages may result in rapid and complete recovery. The return to normal intestinal structure and function may be slower if treatment is begun later in the course of the disease. In some cases, Tropical Sprue may become chronic with frequent relapses.

People with this disorder may develop anemia characterized by the presence of abnormally enlarged blood cells (megaloblastic) in the bone marrow. (For more information on this disorder, choose “Megaloblastic Anemia” as your search term in the Rare Disease Database.)

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Causes

The exact cause of Tropical Sprue is not known. It is an acquired disorder that may be related to environmental and nutritional factors, or Tropical Sprue may be related to an infectious organism (either viral or bacterial), dietary toxin, parasitic infestation, or a nutritional deficiency such as folic acid. Tropical Sprue causes damage to the mucosal lining of the intestine resulting the impaired absorption of food, minerals, and water.

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Affected populations

Tropical Sprue is a rare disorder in temperate regions. It occurs mainly in the tropical regions of the Caribbean, India, South Africa, and Southeast Asia. Transients, tourists and visitors to these areas can be affected.

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Disorders with Similar Symptoms

Symptoms of the following disorders can be similar to those of Tropical Sprue. Comparisons may be useful for a differential diagnosis:

Malabsorption syndromes refer to a group of digestive disorders which are characterized by the impairment of absorption of nutrients and the excessive loss of nonabsorbed substances in the stool. There are many underlying diseases that are associated with these syndromes. Symptoms vary directly with the severity of the disease. Diarrhea and large volumes of fatty stools are consistent symptoms in people with malabsorption syndromes.

Giardiasis is a rare infectious disease of the small intestine caused by the single-celled organism Giardia lamblia. Like Tropical Sprue, this disease is characterized by the impaired absorption of a variety of nutrients by the small intestine. Symptoms may include abdominal cramps, stomach pain, watery diarrhea, excessive gas and fould-smelling stools. Later in the course of the disease, other symptoms such as weight loss and a profound loss of appetite (anorexia) may be encountered. (For more information on this disorder, choose “Giardiasis” as your search term in the Rare Disease Database.)

Crohn’s disease is an inflammatory bowel disease characterized by severe, chronic inflammation of the intestinal wall or other portion of the gastrointestinal tract. Symptoms that may develop over time include nausea, vomiting, fever, night sweats, a general feeling of weakness and waves of abdominal pain and discomfort. Diarrhea and bleeding from the rectum are often present. Crohn’s disease can be difficult to recognize and manage. Diagnosis is often delayed. (For more information on this disorder, choose “Crohn” as your search term in the Rare Disease Database.)

Ulcerative colitis is an acute inflammatory bowel disease characterized by diarrhea and blood in the stools because of multiple, irregular ulcerations of the bowel. Initial symptoms may include a general feeling of weakness (malaise) and fatigue. There amy be abdominal discomfort accompanying a change in frequency and consistency of stools. Weight loss and and a decrease in appetite are also met with. Abdominal pain, cramping and urgency (tenesmus) are also often present. (For more information on this disorder, choose “Ulcerative Colitis” as your search term in the Rare Disease Database.)

Primary sclerosing cholangitis is a rare collagen disorder involving inflammation and blockage of the bile duct, liver ducts, and gallbladder. Later, yellow skin color (jaundice), fever, chills, and/or itching of the skin may appear. Bacterial infections resulting from ulcerative colitis, Crohn’s disease, and/or vasculitis may be associated with the cause of bile duct blockages in this disorder. (For more information on this disorder, choose “Primary Sclerosing Cholangitis as your search term in the Rare Disease Database.)

Chronic erosive gastritis is an inflammatory disorder characterized by multiple lesions in the mucosal lining of the stomach. Symptoms of this disorder may include burning or a heavy feeling in the stomach, mild nausea, vomiting, loss of appetite and/or weight loss. In severe cases, bleeding from the stomach may be so extensive that anemia results. (For more information on this disorder, choose “Chronic Erosive Gastritis” as your search term in the Rare Disease Database.)

Irritable bowel syndrome, also known as spastic colon, is a common digestive disorder that involves both the small intestine and the large bowel. Patients with irritable bowel syndrome who have “painless diarrhea” may experience an urgent need to defecate upon arising. (For more information on this disorder, choose “Irritable Bowel Syndrome” as your search term in the Rare Disease Database.)

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Standard Therapies

Treatment for Tropical Sprue includes the use of folic acid, cobalamin, and antibiotics such as tetracycline, oxytetracycline, or ampicillin. The dosage of these medications depends on the severity of the disorder as well as how the patient responds to the therapy. Combined therapy with folic acid and tetracycline seems to rapidly reduce the severity of the symptoms and also heal unhealthy tissue in the small intestine. Other nutrients may be given as needed (i.e., iron, vitamin B12). Diarrhea associated with this disorder may be controlled with anti-diarrhea agents.

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Clinical Trials and Studies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. Government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com

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References

TEXTBOOKS

Cecil Textbook of Medicine, 20th Ed.: J. C. Bennett & F. Plum, Editors; W.B. Saunders Co., 1996. Pp. 705-06.

The Merck Manual, 17th Ed.: Mark H. Beers and Robert Berkow , Eds.; Merck Research Laboratories, 1999. Pp. 300-01.

Mayo Clinic Family Health Book, 2nd Ed., David E. Larson, Ed. William Morrow and Company, Inc., 1996, P. 971.

JOURNAL ARTICLES

Persistent Diarrhea in the Returned Traveler. N. M. Thielman et al., Infect Dis Clin North Am. (Jun 1998, 12 (2)), Pp. 489-501.

Tropical Sprue and Subclinical Enteropathy: A Vision for the Nineties.

P Haghighi et al., Crit Rev Clin Lab Sci. (Aug1997, 34 (4)), Pp. 313-41.

FROM THE INTERNET

https://www.nlm.nih.gov/medlineplus/print/ency/article/000275/htm

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Programs & Resources

RareCare^® Assistance Programs

NORD strives to open new assistance programs as funding allows. If we don’t have a program for you now, please continue to check back with us.

Additional Assistance Programs

MedicAlert Assistance Program

NORD and MedicAlert Foundation have teamed up on a new program to provide protection to rare disease patients in emergency situations.

Learn more https://rarediseases.org/patient-assistance-programs/medicalert-assistance-program/

Rare Disease Educational Support Program

Ensuring that patients and caregivers are armed with the tools they need to live their best lives while managing their rare condition is a vital part of NORD’s mission.

Learn more https://rarediseases.org/patient-assistance-programs/rare-disease-educational-support/