Tropical sprue: revisited

To review the experience of patients presenting with clinical manifestations of tropical sprue and assess their diagnosis and management, response to treatment and follow up. This single center retrospective descriptive study was done at Shifa International Hospital, Islamabad from January 1994 to January 2003. All patients who presented with diarrhea, anorexia, weight loss and anemia and who proved to have partial villous atrophy on intestinal biopsy and had responded to treatment with antibiotic and folic acid,were included in this review. A total of 42 patients were encountered during these years. There were 31 [74.0%] males and 11 [26%] females. The age ranged from 17-66 years. All patients presented with diarrhea, weight loss, anorexia and had megaloblastic anemia. In all patients, a distal duodenal biopsy showed partial villous atrophy. All were treated with tetracycline 1 g per day and folic acid 5 mg per day and responded to treatment within 4 weeks. Total treatment lasted 3 months and resulted in complete resolution of symptoms and gain of weight. The follow up lasted for a mean of 5 years and no relapses were noted. Tropical sprue presents with diarrhea, anorexia, weight loss, and megaloblastic anemia. The partial villous atrophy has been a constant finding. The response to treatment to tetracycline and folic acid has been uniformly successful

Mala absorción tropical en Bogotá / Tropical malabsorption in Bogota

Se presentan 75 casos de mala absorción tropical, 65 adultos y 10 niños, estudiados desde el año de 1968 en el Hospital San Juan de Dios de Bogotá. La mayoría de los pacientes provenían de Cundinamarca y del Distrito Especial de Bogotá. En todos hubo mala absorción de la D-xilosa y esteatorrea. La biopsia peroral de la mucosa intestinal practicada en 64, mostró atrofia de 1+ en 16, de 2+ en 30, de 3+ en 18 y en ninguno se observó atrofia de 4+. Se encontró anemia en 58 pacientes, la cual fue de tipo megaloblástico en 45 (60 por ciento), ocasionada a su vez por deficiencia de ácido fólico, en 4, de Vitamina B12 en 9 y de ácido fólico y Vitamina B12 en 32. Fueron hallazgos frecuentes además del peso bajo, la glositis, la carotinemia baja (<40ug/dl) la colesterolemia inferior a 150mg/dl y la albuminemia por debajo de 3.5 g/dl. Fueron tratados exitosamente con dieta balanceada, ácido fólico, Vitamina B12, tetraciclina o sulfas, en forma aislada o empleando combinaciones de estos medicamentos. En presencia de megaloblastosis la terapia ideal es el tratamiento "triconjugado" de Vitamina B12, ácido fólico y tetraciclina; solamente falleció un paciente, por tromboembolismo pulmonar. El diagnóstico diferencial debe hacerse principalmente con la enteropatía por Gluten y con la anemia perniciosa