Tropical sprue

This disease is caused by damage to the lining of the small intestine. It comes from having too much of certain types of bacteria in the intestines.

Risk factors are:

• Living in the tropics
• Long periods of travel to tropical destinations

Symptoms include:

• Abdominal cramps
• Diarrhea, worse on a high-fat diet
• Excess gas (flatus)
• Fatigue
• Fever
• Leg swelling
• Weight loss

Symptoms may not appear for up to 10 years after leaving the tropics.

There is no clear marker or test that clearly diagnoses this problem.

Certain tests help to confirm that poor absorption of nutrients is present:

• D-xylose test to see how well the intestines absorb a simple sugar
• Tests of the stool to see if fat is absorbed correctly
• Blood tests to measure iron, folate, vitamin B12, or vitamin D
• Complete blood count (CBC)

Tests that examine the small intestine may include:

• Enteroscopy
• Upper endoscopy
• Biopsy of the small intestine
• Upper GI series

Treatment begins with plenty of fluids and electrolytes. Replacement of folate, iron, vitamin B12, and other nutrients may also be needed. Antibiotic therapy with tetracycline or trimethoprim with sulfamethoxazole is typically given for 3 to 6 months.

In most cases, oral tetracycline is not prescribed for children until after all the permanent teeth have come in. This medicine can permanently discolor teeth that are still forming. However, other antibiotics can be used.

The outcome is good with treatment.

Vitamin and mineral deficiencies are common.

In children, sprue leads to:

• Delay in the maturing of bones (skeletal maturation)
• Growth failure

Contact your health care provider if:

• Tropical sprue symptoms get worse or do not improve with treatment.
• You develop new symptoms.
• You have diarrhea or other symptoms of this disorder for a long period of time, especially after spending time in the tropics.

Other than avoiding living in or traveling to tropical climates, there is no known prevention for tropical sprue.

Ramakrishna BS. Tropical diarrhea and malabsorption. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 108.

Semrad CE. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 126.

Updated by: Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria - Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.