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

Tropical sprue is rare unless you live in or visit tropical areas. Specifically, it generally occurs in the tropical areas of:

• the Caribbean
• India
• South Africa
• Southeast Asia

Researchers believe the condition is caused by an overgrowth of bacteria in your intestines. The specific bacteria that cause tropical sprue are unknown.

Many other conditions have symptoms similar to tropical sprue. These include:

• giardiasis
• Crohn’s disease
• ulcerative colitis
• irritable bowel syndrome

Other more rare conditions include primary sclerosing cholangitis and chronic erosive gastritis.

Your doctor will order a series of tests to rule out these conditions. If your doctor can’t find a reason for your symptoms, and you live or have visited a tropical area, they may assume you have tropical sprue.

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
• folate level
• vitamin B12 level
• vitamin D level

Your doctor may also use an enteroscopy 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.

During the enteroscopy, a small sample of tissue may be removed. This removal process is called a biopsy, and the sample will be analyzed. If you have tropical sprue, there may be signs of swelling in the lining of your small intestine.

Antibiotics

Tropical sprue is treated with antibiotics. This kills the bacteria overgrowth that results in this condition. Antibiotics may be given for a period of two weeks or one year.

Tetracycline is the most commonly used antibiotic for treating tropical sprue. It’s widely available, inexpensive, and has been proven to be effective. Other broad-spectrum antibiotics may also be prescribed, including:

• sulfamethoxazole and trimethoprim (Bactrim)
• oxytetracycline
• ampicillin

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. Children will receive a different antibiotic instead. The dosage will vary depending on your symptoms and response to treatment.

Treating Malabsorption

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

• fluids and electrolytes
• iron
• folic acid
• vitamin B12

Folic acid should be given for at least three months. You may improve quickly and dramatically after your first large dose of folic acid. Folic acid may be enough to improve symptoms on its own. Vitamin B12 is recommended if your levels are low or symptoms last for more than four months. Your doctor may also prescribe antidiarrheal medications to control symptoms.

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 the Postgraduate Medical Journal, most people show good outcomes after three to six months of treatment.