Tropical Sprue: Causes, Symptoms, Treatment and Cost

Tropical sprue is an intestinal condition caused by malabsorption, usually affecting people living in or travelling to tropical regions.

There are two types of tropical sprue:- primary tropical sprue and secondary tropical sprue.

• Primary tropical sprue: It occurs when the body is exposed to an infection or toxins found in foods such as shellfish or salted fish. This type of tropical sprue is more common in Southeast Asia and India.
• Secondary tropical sprue: It occurs when the body has an immune reaction to a particular illness or medication. This type of tropical sprue is more common in people from Latin America, Caribbean countries and West Africa.

It is believed to be caused by a combination of dietary changes, poor sanitation, and infection from parasites and bacteria. These microorganisms disrupt the balance of helpful bacteria normally found in the intestine, leading to malabsorption of vital nutrients and other complications. Other potential causes include stress, hormonal changes, and genetic predisposition

• Abdominal pain and cramps.
• Severe, continuous diarrhoea.
• Greasy stools that tend to float.
• Bloating and gas.
• Weight loss due to malabsorption of nutrients.
• Anaemia due to vitamin B12 deficiency.
• Fatigue or weakness.
• Loss of appetite.

• Follow a diet rich in antioxidants, vitamins and minerals.
• Live an active lifestyle with regular exercise.
• Avoid food that is contaminated or unsafe to consume, such as raw seafood or undercooked meats.
• Properly wash all fruits and vegetables before consuming them.
• Drink safe and filtered water when travelling in areas where drinking water may be unsafe.
• Avoid being exposed to areas known to be at risk for tropical spring, such as Africa and the Caribbean region of South America.

Common diagnosis tests for Tropical Sprue include:

• Serology Tests:Tests that measure specific antibodies, such as anti-gliadin, anti-endomysial, or anti-tissue transglutaminase, can help diagnose Tropical Sprue.
• Stool Sample Test:Stool samples are examined for fat and protein levels to determine whether malabsorption is occurring.
• Intestinal Biopsy:A biopsy of the small intestine can be used to diagnose an infection or reveal evidence of modifications due to malabsorption such as changes in the structure or number of cells in the villi and an increased number of lymphocytes in the area (small intestinal lymphocytic infiltration).
• Colonoscopy:A colonoscopy is a procedure that allows doctors to view areas deep within the colon and rectum using a long camera attached to a flexible tube (endoscope). It can reveal more advanced stages of malabsorption through signs such as blunting or flattening of villi (atrophy) along with inflammation and changes in cell shape (dysplasia).
• Blood Tests:These tests measure levels of vitamins B12 and folate which can be deficient due to malabsorption caused by Tropical Sprue.

• Malabsorption:Poor absorption of nutrients due to damage or infection in the small intestine, leading to nutrient and energy deficiency.
• Abnormal Fat Metabolism:Impaired ability to convert dietary fat into usable energy resulting in steatorrhea (increase in fats in stool).
• Anaemia:Persistent decrease of red cells, caused either by inadequate dietary intake or impaired absorption of nutrients needed for red cell production.
• Weakness and Weight Loss:Symptoms associated with malabsorption, causing wasting of muscle tissue, loss of muscle strength and reduced body weight over time.
• Developmental Delay:Poor growth and nutrition can lead to delayed physical and mental development in children suffering from tropical sprue.

• Take medicinal herbs such as ashwagandha and Amalaki to boost immunity and digestion.
• Drink dandelion tea, ginger tea or buttermilk which are known to be beneficial for treating tropical sprue.
• Practise yoga poses and breathing exercises such as Kapalbhati Pranayama that can help improve the health of the digestive system.
• Follow a healthy skin care routine by using natural products like neem powder to reduce inflammation associated with tropical sprue.

• When it comes to eating with tropical sprue, the best approach is to follow a diet high in complex carbohydrates, such as whole grains, legumes, fruits and vegetables.
• Meals should be low in fat and include lean proteins like fish, poultry or beans.
• Consume sufficient amounts of healthy fats like olive oil or nuts to help the body absorb vitamins A, D, E, and K which are essential for proper absorption of nutrients.
• Focus on consuming a lot of water-soluble vitamins such as B-complex vitamins and vitamin C each day as they help reduce running symptoms associated with tropical sprue.

• Avoid dairy products as lactose intolerance may worsen symptoms in some individuals, but yoghurt containing live cultures may be consumed in moderation if tolerated.
• Reduce or avoid fatty foods as they may worsen diarrhoea symptoms caused by tropical sprue.
• Avoid wheat products as gluten intolerance is common among those with this condition; try using alternative flours like almond flour or coconut flour when baking at home instead of wheat flour.

• Diet Modification:Cutting back on fatty and processed foods while increasing dietary fibre can help to improve digestion and absorption of nutrients in people with tropical sprue.
• Dietary Supplements:Vitamin B12, folic acid and other vitamins may be prescribed to help restore nutritional deficiencies caused by tropical sprue.
• Resection and small bowel anastomosis:Resection of part of the large intestine and reconnecting the remaining two pieces using a suture or other material.
• Enteral Jejunostomy anastomosis:Creating an opening in the small intestine (jejunum), by cutting and suturing to another area within the small intestine to aid in digestion and absorption.
• Gastrojejunostomy:Establishing a connection between stomach and jejunum to allow food passage from stomach directly into the jejunum bypassing duodenum, potentially reducing malabsorption symptoms caused by tropical sprue.
• Total abdominal colectomy with rectal pull through procedure:Performed when patients have colonic involvement or recurrent manifestations of tropical sprue; involves removing affected parts of large bowel and rectal tissue, then reattaching the rectal tube after performing a coloanal anastomosis at its normal distal site.

It is recommended to seek medical help from a gastroenterologist who specialises in digestive diseases, as they are best trained to accurately diagnose and treat tropical sprue.

• Proton Pump Inhibitors (PPI):These help to reduce levels of acid in the stomach and intestines by blocking the action of an enzyme responsible for producing acid. Examples of PPIs include omeprazole (Prilosec), lansoprazole (Prevacid) and pantoprazole (Protonix).
• Antibiotics:These are used to treat bacterial overgrowth in the small intestine, which can cause malabsorption. Examples include tetracycline, sulfasalazine, and metronidazole.
• Laxatives:These are taken to treat constipation and help transport nutrients through the gut more effectively. Examples include polyethylene glycol 3350 (Miralax) and lactulose syrup (Cephulac).
• Probiotics:These may be beneficial in restoring a normal balance of healthy bacteria in the intestines, helping to improve digestion and absorption of nutrients from food sources. Common strains include Lactobacillus acidophilus, Bifidobacterium bifidum, and Saccharomyces boulardii.

The length of recovery depends on the response to treatment. Generally, it may take anywhere from several months to more than a year for doctor visits and adjustments in medication before an individual starts to feel better.

Treatment for tropical sprue generally results in a significant improvement in clinical symptoms and small intestine histologic features.

However, relapse is possible, so it is important to follow the treatment plan set out by the physician and demonstrate ongoing compliance with lifestyle and dietary recommendations.

• Take medications prescribed to reduce inflammation and treat infection, such as antibiotics or proton pump inhibitors.
• Follow up with your doctor for regular follow-up appointments to monitor the response to treatment.
• Make dietary changes recommended by your healthcare provider, such as avoiding processed foods and increasing fibre intake if needed.
• Utilise any additional nutritional supplements recommended by the doctor, such as vitamin B12 or calcium supplements.
• Remain under close monitoring of your health care provider in order to report any side effects or changes in symptoms that may occur following surgery or treatment with medications or other therapies for tropical sprue.

The cost of treating tropical sprue in India varies depending on the severity of the condition. Generally, medications and supplements can cost anywhere between Rs 500-3000 per month, while hospitalisation may cost up to Rs 30,000 depending on the duration of stay.

Additional tests such as endoscopy or imaging may cost up to Rs 4000-5000. Surgery is rarely required for tropical sprue, but if necessary can range from Rs 25,000 to Rs 50,000+.

• Tropical Sprue treatments can have many side effects. These include:
• Gastrointestinal distress such as nausea, vomiting, and abdominal pain.
• Electrolyte imbalances that may manifest as fatigue or muscle weakness.
• Skin rashes or itching.
• Bone and joint pain.
• Increased risk of infection and lowered immune system function.

If you are suffering from any complications relating to tropical sprues then you should consult a doctor nearby as they can cause complications like 'abnormal fat metabolism, anaemia, developmental delay' in which treatment courses can range from a few months to years depending on the severity of the situation.