Tropical Sprue: A Forgotten Contributor to Malabsorption Syndrome in Endemic Regions (KEY IJP************253)

• Abhishek Rajput

Abstract

Tropical sprue(TS) is a chronic malabsorptive disorder endemic to tropical regions, presenting withchronic diarrhea, abdominal pain, bloating, weight loss and micronutrient deficiencies such as folateand vitamin B12. Its pathogenesis remains unclear, with intestinal dysbiosis and bacterial overgrowthplaying central roles. Histologically, TS is characterized by partial villous atrophy, crypt hyperplasia,and inflammatory cell infiltration of the lamina propria, occasionally with eosinophilic involvement.Diagnosis requires a systematic approach. Detailed history-taking is essential to assess gastrointestinalsymptoms, weight loss, and signs of nutrient deficiencies, including anemia(duodenal involvement),bone pain(vitamin D deficiency) and peripheral neuropathy(vitamin B12 deficiency). Travel history totropical regions and past medical history, such as chronic pancreatitis or small bowel surgery, helpexclude other causes. Stool microscopy for ova or trophozoites, stool culture for Yersinia enterocoliticaon CIN agar, and test to exclude Clostridioides difficle are necessary. The Marsh classification aids isin differentiating TS from other malabsorptive disorders like celiac disease.Management combines antibiotic therapy, such as tetracycline or doxycycline for 3 to 6 months withfolate and vitamin B12 supplementation. This dual approach generally results in full clinical recovery,though relapses may occur in endemic areas.This article highlights the importance of thorough diagnostic strategy, emphasizing, history-taking andtargeted investigations, to accurately identify TS. Enhanced awareness and research into itsmicrobiological and immunological mechanisms could further improve diagnostic accuracy andtherapeutic outcomes.