Tropical Sprue

Written by Jacquelyn Cafasso | Published on August 20, 2012
Medically Reviewed by George Krucik, MD

What is Tropical Sprue?

Tropical sprue is caused by inflammation of your intestines. This swelling makes it more difficult for you to absorb nutrients from food. This is also called malabsorption. Tropical sprue makes it particularly difficult to absorb folic acid and vitamin B-12.

If you suffer from malabsorption, you are not getting enough vitamins and nutrients in your diet. This can cause a number of different symptoms. Your body needs the vitamins and nutrients to function properly.

What Causes Tropical Sprue?

Tropical sprue is rare unless you live in or visit tropical areas.

Researchers believe the condition is caused by an overgrowth of bacteria in your intestines. The specific bacteria that cause tropical sprue are unknown. However, according to a 2003 study published in the Journal of Gastroenterology and Hepatology, patients typically respond to antibiotics (Ghoshal, et al., 2003).

You may be at risk for tropical sprue if you:

  • live in a tropical area
  • have traveled through a tropical area for a long period of time

What Are the Symptoms of Tropical Sprue?

Symptoms of tropical sprue may include any of the following:

  • abdominal cramps
  • diarrhea, which may get worse on a high-fat diet
  • excessive gas
  • indigestion
  • irritability
  • muscle cramps
  • numbness
  • paleness
  • weight loss

How Is Tropical Sprue Diagnosed?

Many other conditions have symptoms similar to tropical sprue. Your doctor may order a series of tests to look for such causes. If your doctor cannot find a reason for your symptoms, and you live in a tropical area, he or she may assume you have tropical sprue. Your doctor may also diagnose tropical sprue if you have recently traveled to the tropics.

One way to diagnose tropical sprue is to look for signs of the nutritional deficiencies it causes. Tests for damage caused by malabsorption include:

  • bone density test
  • complete blood count (CBC)
  • folate level (blood test)
  • vitamin B-12 level (blood test)
  • vitamin D level

An enteroscopy may be used to confirm your diagnosis. During this test, a thin tube is inserted through your mouth into your gastrointestinal tract. This allows your doctor to see any changes in the small intestine.

A small sample of tissue may be removed (biopsy) during the enteroscopy and sent for analysis. If you have tropical sprue, there may be signs of swelling in the lining of your small intestine.

How Is Tropical Sprue Treated?


Tropical sprue is treated with antibiotics. This kills the bacteria that cause the condition. Antibiotics may be given for a period between two weeks and one year.

According to the British Medical Journal (BMJ), tetracycline is the most commonly used antibiotic for treating tropical sprue. It is widely available, not expensive, and it has been proven effective. Other broad-spectrum antibiotics may also be prescribed. However, there is not much evidence to prove their effectiveness (BMJ).

Tetracycline is usually not prescribed in children until they have all their permanent teeth. This is because tetracycline can discolor teeth that are still forming. These children will receive a different antibiotic instead.

Treating Malabsorption

In addition to killing the bacteria that cause tropical sprue, you will need to be treated for malabsorption. Your doctor will give you the vitamins, nutrients, and electrolytes that your body is lacking. This type of supplementation should begin as soon as you are diagnosed. You may be given:

  • fluids and electrolytes
  • iron
  • folate
  • vitamin B-12

Folate should be given for at least three months. You may improve quickly and dramatically after your first large dose of folate. Folate may be enough to improve symptoms on its own. Vitamin B12 is recommended if your levels are low or symptoms last more than four months (BMJ).

Long-Term Outlook and Potential Complications of Tropical Sprue

The most common complications of tropical sprue are vitamin and mineral deficiencies. The condition can lead to growth failure and problems with bone maturation in children.

With proper treatment, the outlook for tropical sprue is very positive. According to BMJ, most people show good outcomes after three to six months of treatment (BMJ).

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