Tropical sprue

Malabsorption syndrome Steatorrhea Tropical sprue Idiopathic hypercalcemia... 

Effects in Patients with Idiopathic Steatorrhea and Tropical Sprue. 89... 

In tropical sprue, both in Hong Kong and in Puerto Rico, folic acid deficiency is a constant and early feature (B25, F18). Its importance in sprue was first demonstrated by Spies and his colleagues (S18) in the West Indies. However, it cannot be concluded that tropical sprue is simply due to dietary folic acid deficiency. In Hong Kong the condition may develop in a previously healthy individual on an adequate... 

In tropical sprue, gluten does not appear to play much part in relatively early cases, such as those studied in Hong Kong. There is evidence, however, that patients with chronic sprue of many years duration may show some improvement on a gluten-free diet (C2). This may be a secondary phenomenon, due to general reduction of the enzymes in the small intestinal mucosa other mucosal enzymes have been shown to be reduced or ineffective in these patients. The important question is whether such patients will still react to gluten when the mucous membrane is brought back to normal by appropriate therapy, if this can be achieved. The rehabilitation of a malnutritional state induced over a period of many years is an extremely complex problem. 

All. Asenjo, C. F., Rodriguez-Molina, R., Cancio, M., and Bemabe, R. A., Influence of very low fat diets, with and without gluten, on the endogenous fecal-fat excretion of patients with tropical sprue. Am. J. Trop. Med. Hyg. 7, 347-352 (1958). 

C7. Cintron-Rivera, A. A., Folinic acid excretion in tropical sprue. Proc. Conf. Megaloblastic Anaemias and Intestinal Absorption, Puerto Rico, 1960. 

F3. Fink, S., and Laszlo, D., A metabolic study following oral calcium 45 administration in a patient with non-tropical sprue. Gastroenterology 32, 689-703... 

F14. Frazer, A. C., Disordered gastro-intestinal function and its relationship to tropical sprue, coeliac disease and idiopathic steatorrhoea. Trans. Boy. Soc. Trop. Med. Hyg. 46, 576 (1952). 

L5. Lepore, M. J., Long-term or maintenance adrenal steroid therapy in non-tropical sprue. Am. J. Med. 25, 381-390 (1958). 

Spies, T. D., Lopez, G. G., Milanes, F., Toca, R. L., Reboredo, A., and Stone, R. E., The response of patients with pernicious anemia, with nutritional macrocytic anemia and with tropical sprue to folinic acid or citrovorum factor. Southern Med. J. 43, 1076-1082 (1950). 

Strauss, E. W., Padykula, H. A., Ladman, A. J, and Gardner, F. H., Histo-chemical, histologic and electron microscopic observations on jejunal epithelium in non-tropical sprue. Am.. Pathol. 35, 716 (1959). 

The intestine usually constitutes an effective immunological barrier to an invasion by pathogens but this protection can be overwhelmed by frequent repeat attacks. This may explain the prevalence of sprue in the tropics (hence the name, tropical sprue) especially for visitors who are unaccustomed to contaminated food and water and hence have no immune protection against the bacteria specific to that part of the tropics. 

Glucocorticoid antagonism Idiopathic hypercalcemia Malabsorption syndrome Sarcoidosis Steatorrhea Tropical sprue... 

Normally there is very little fat in the feces. However, fat content in stools may increase because of various fat malabsorption syndromes. Such increased fat excretion is steatorrhea. Decreased fat absorption may be the result of failure to emulsify food contents because of a deficiency in bile salts, as in liver disease or bile duct obstruction (stone or tumor). Pancreatic insufficiency may result in an inadequate pancreatic lipase supply. Finally, absorption itself may be faulty because of damage to intestinal mucosal cells through allergy or infection. An example of allergy-based malabsorption is celiac disease, which is usually associated with gluten intolerance. Gluten is a wheat protein. An example of intestinal infection is tropical sprue, which is often curable with tetracycline. Various vitamin deficiencies may accompany fat malabsorption syndromes. 

Chronically abnormal epithelium Amyloidosis Coeliac disease Crohn s disease Ischaemia Radiation enteritis Tropical sprue Whipple s disease... 

DEFICIENCY Pernicious anemia. Conceivably, one could get Bi2 deficiency on a purely vegetarian diet, but this is rare. Deficiency is more likely with diseases of the intestine that impede absorption (e.g., tropical sprue, regional enteritis). The tapeworm Diphyllobothrium latum may deplete Bi2 stores. A deficiency of gastric intrinsic factor (a glycoprotein) may result in Bj2 deficiency, as intrinsic factor is important in facilitating Bj2 absorption in the bowel. Intrinsic factor deficiency may occur following gastrectomy or as an entity in itself, in pernicious anemia. Intrinsic factor deficiency sometimes results from an autoimmune disease. 

Malabsorption syndromes. Particularly in gluten-sensitive enteropathy and tropical sprue, poor absorption of folic acid from the small intestine often leads to a megaloblastic anaemia. 

Tropical sprue is a malabsorptivc disease thought to be generated by specific types of infections. 1 he disease involves diarrhea and is associated with the malabsorption of folate. Hence, its treatment may involve supplements of folic add. 

Tiiiodotbyiwiine (731, 733-734, 826 Tiimelhyllysiiie, 224-225 Tripalinitatc, chemical structure, 23 tRNA (transfer RNAJ, 34,38 tRNA-guaninc transglycosylase, 150 Tropical oils, 362 Tropical sprue, 152 Tidponin, 790,793 Trypsin, 63,88... 

Intestinal malabsorption of vitamin B12 may be caused by gastrectomy or ileal resection, with an inverse relationship between the length of ileum resected and the absorption of vitamin B12. Other causes of malabsorption are tropical sprue, inflammatory disease of the small intestine, intestinal stasis with overgrowth of colonic bacteria, which consume the vitamin 6,2 ingested by the host, and HIV infection. Another cause of vitamin B malabsorption is failure to extract cobalamin from food. Some patients fail to absorb cobalamin bound to food, whereas absorption of nonfood-bound cobalamin in the Schilling test is unimpaired. This is particularly a problem in patients with compromised gastric status or early in the course of development of pernicious anemia. 

Malabsorption Syndromes. Patients at risk include those with celiac disease, tropical sprue, cystic fibrosis, and short bowel syndrome. Excessive intake of oral zinc supplements can cause anemia and hematological abnormalities in the absence of occult blood loss. The copper deficiency is caused by zinc induction of metallothionein in the mtesti-nal mucosa, which then sequesters dietary copper, blocking its absorption. 

Small bowel disease Mucosal lesion e.g. Celiac disease Tropical sprue Bacterial overgrowth deconjugation of bile salts) Parasites e.g. Giardia Intestinal resection Ileal disease - Crohn s Abetalipoproteinemia Drugs... 

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