Diagnosis of Tropical Sprue

Tropical sprue should be suspected in anyone with megaloblastic anaemia and malabsorption who has lived in an endemic region. Biopsy of the jejunum shows typical abnormalities. Intestinal villi become shorter and broader. In the intestinal wall there is an inflammatory infiltrate, chiefly consisting of lymphocytes, plasma cells and a few eosinophils. The enterocytes exhibit large vacuoles. Radiography of the small intestine shows non-specific changes. There is flocculation of the contrast material and segmentation of the barium column, distension of the lumen and thickening of the mucosa. The mucosal folds in the small intestine are irregular and thickened, which gives the impression of a stack of coins. In advanced cases, no mucosal folds at all can be seen. There is no deconjugation of bile salts, unlike, for example, in the blind-loop syndrome. A flat mucosa is very unusual and should lead to suspicion of a different disease (e.g. gluten enteropathy).

Category: Medical Subject Notes , Medicine Notes