Aetiology and Pathogenesis of Postinfective Tropical Malabsorption (Tropical Sprue)

Cook, Gordon

doi:10.1016/s0140-6736(84)92231-1

Cited by 67 publications

(20 citation statements)

References 40 publications

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“…Though the alterations in the intestinal permeability o f patients with TM reported here are similar to those found in GE, the structural abnormality o f the jejunal mucosa is notably less severe [1][2][3]. The rise in plasma concentration during the D-xyl ab sorption test shows marked impairment in both conditions, but delayed absorption peaks, so characteristic o f GE, were not seen in any o f our patients with TM; maxima occurred by 60 min (fig.…”

Section: Plasma Z)-xyl and 3mglc Concentration/ Time Curves After Ingmentioning

confidence: 87%

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Intestinal Absorption and Unmediated Permeation of Sugars in Post-Infective Tropical Malabsorption (Tropical Sprue)

Cook¹,

Menzies²

1986

Digestion

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Differential absorption of D-xylose and 3-O-methyl-D-glucose, and unmediated intestinal permeation of lactulose and L-rhamnose has been investigated in 14 patients with diarrhoea following tropical exposure and in 16 healthy control subjects. Five had malabsorption of fat, D-xylose and B₁₂ (‘tropical malabsorption’ (TM) group), and that was absent or minimal in the others (‘tropical diarrhoea’ (TD) group). After combined ingestion of the four test sugars in iso-osmolar solution a marked depression in plasma D-xylose concentration (with a slow rise) occurred in all of the TM group; the TD group did not differ significantly from the controls. In contrast, 3-O-methyl-.D-glucose absorption was similar in all three groups. Urine analysis demonstrated that intestinal permeation of lactulose was increased and that of rhamnose decreased in the TM group compared with the controls. Ingestion as a hyperosmotic solution further enhanced abnormal lactulose permeation in the TM group. Although some of the TD group showed one or the other of these changes, discrimination of the TM group from the TD and control groups was improved when results were expressed as lactulose/rhamnose differential permeation ratios, especially when using a hyperosmotic stress. Similar abnormalities have previously been demonstrated in untreated gluten-induced enteropathy (coeliac disease). The magnitude of the absorption defects demonstrated in TM are more severe than would be anticipated from the jejunal mucosal abnormalities alone; this suggests that there is probably significant pathology in the distal small intestine (including the ileum) in TM.

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Section: Plasma Z)-xyl and 3mglc Concentration/ Time Curves After Ingmentioning

confidence: 87%

“…with an acute (usually infective) onset which, untreated, progresses to prolonged diarrhoea, malabsorption and weight loss [1][2][3]. Early cases have abnormalities o f the jejunal mu cosa that are mild compared with those of untreated gluten-induced enteropathy (GE.…”

Section: Post-infective Tropical Malabsorption (Tm) (Tropical Sprue) mentioning

confidence: 99%

Intestinal Absorption and Unmediated Permeation of Sugars in Post-Infective Tropical Malabsorption (Tropical Sprue)

Cook¹,

Menzies²

1986

Digestion

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“…TS has not been described in Jamaica or sub-Saharan Africa [6]. The etiology remains elusive, but it has been suggested that persistent infection may be responsible and it is also referred to as ‘post-infective tropical malabsorption’ [7,8]. Contamination of the small bowel by aerobic enteric bacteria is seen with TS patients, but no specific causal agent has ever been found [9,10].…”

Section: Discussionmentioning

confidence: 99%

The Face of Tropical Sprue in 2010

Batheja

Leighton

Azueta

et al. 2010

Case Rep Gastroenterol

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Tropical sprue (TS), although endemic in certain tropical regions of the world, is rarely seen in North America and Europe. However, in this era of globalization and worldwide travel, it is important for all clinicians to be aware of the possibility of TS in patients presenting with nonspecific, persistent gastrointestinal complaints like diarrhea and weight loss. The symptoms and histologic findings of TS can resemble and be confused with those of diseases seen more commonly in nontropical climates like celiac disease and small intestine bacterial overgrowth. Therefore, if the usual causes of persistent diarrhea are ruled out, keeping a high index of suspicion for TS in patients who have a travel history to one of the endemic regions is important.

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“…Baker and Klipstein 78 suggested that the diagnosis of tropical sprue should be made only when there is malabsorption of two or more unrelated nutrient groups (eg, fat and carbohydrate), and after other known causes of malabsorption have been excluded. Cook 79 proposed the term ''post-infectious tropical malabsorption'' to describe a syndrome of malabsorption in travellers returning to the UK in whom the illness was preceded by an acute diarrhoeal illness and who had evidence of jejunal colonisation with aerobic and anaerobic bacteria.…”

Section: Definitionmentioning

confidence: 99%

“…90 91 However, no single causative infectious agent was identified, and the bacteria were of several different kinds, suggesting that bacterial colonisation was secondary to small intestinal stasis. 79 On the other hand, a specific overgrowth of coliforms in the small intestine was described in rural Haitians with tropical sprue. 92 The organisms were Klebsiella, Enterobacter or Escherichia coli, and produced toxins that caused mucosal damage and secretion in intestinal loops of experimental animals.…”

Section: Aetiologymentioning

confidence: 99%

Tropical malabsorption

Ramakrishna

Venkataraman

Mukhopadhya

2006

Postgraduate Medical Journal

125

100

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Malabsorption is an important clinical problem both in visitors to the tropics and in native residents of tropical countries. Infections of the small intestine are the most important cause of tropical malabsorption. Protozoal infections cause malabsorption in immunocompetent hosts, but do so more commonly in the setting of immune deficiency. Helminth infections occasionally cause malabsorption or protein-losing enteropathy. Intestinal tuberculosis, chronic pancreatitis and small-bowel bacterial overgrowth are important causes of tropical malabsorption. In recent years, inflammatory bowel disease and coeliac disease have become major causes of malabsorption in the tropics. Sporadic tropical sprue is still an important cause of malabsorption in adults and in children in South Asia. Investigations to exclude specific infective, immunological or inflammatory causes are important before considering tropical sprue as a diagnosis. This article briefly reviews the management of tropical sprue and presents an algorithm for its investigation and management.

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Aetiology and Pathogenesis of Postinfective Tropical Malabsorption (Tropical Sprue)

Cited by 67 publications

References 40 publications

Intestinal Absorption and Unmediated Permeation of Sugars in Post-Infective Tropical Malabsorption (Tropical Sprue)

Intestinal Absorption and Unmediated Permeation of Sugars in Post-Infective Tropical Malabsorption (Tropical Sprue)

The Face of Tropical Sprue in 2010

Tropical malabsorption

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