Tropical sprue is prevalent among residents of tropical regions, most commonly found in South America, Africa, India, and Southeast Asian countries. It can affect individuals of any age. In recent years, cases occurring in tropical areas have been classified under "infectious malabsorption," and the condition is divided into two types: parasitic (i.e., giardiasis) and non-parasitic (tropical sprue). The milder form of the latter is also referred to as type c.

bubble_chart Etiology

The cause of the disease has not been fully elucidated. It is currently believed to be a chronic small intestine infection possibly caused by one or more pathogenic microorganisms or Chinese Taxillus Herb insects, with no clear relationship to a gluten-containing diet. The disease exhibits epidemic and seasonal characteristics, and broad-spectrum antibiotics are effective in treatment. However, no pathogenic bacteria have been found in feces, small intestine contents, or intestinal mucosa. Nutritional deficiencies, such as proteins, B vitamins, and folic acid, may be related to the onset of the disease but are not significant causes.

bubble_chart Pathological Changes

The small intestinal mucosa shows irregular villous deformities, which may be thickened or flattened, appearing in the form of tongues, ridges, or flat, curled shapes. Jejunal mucosal biopsy reveals elongated crypts, hypertrophic crypt cell nuclei, increased argentaffin cells, squamous or flattened epithelial cells, and reduced goblet cells. The enzymatic activity of epithelial cells is decreased. Electron microscopy reveals irregular microvilli with frequent branching and clustering, as well as increased microsomes and mitochondria. Some cases also present with superficial or atrophic gastritis.

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There is a lack of strength, abdominal pain, and diarrhea, with bowel movements occurring 1-2 times daily or even over ten times a day. The stool is voluminous, pasty in consistency, pale in color, foul-smelling, and greasy with foam. Approximately 30% of cases present with steatorrhea. Hypoalbuminemia is observed, and the oral protein tolerance test indicates delayed absorption. In 50% of patients, glucose tolerance is abnormal, while about 90% of cases show reduced urinary excretion in the xylose absorption test. The absorption tests for vitamin A and B₁₂ are also abnormal.

bubble_chart Diagnosis

The diagnosis can be made based on the area of onset, clinical manifestations, impaired small intestine absorption function, and pathological findings from small intestine biopsies. It should be differentiated from giardiasis, intestinal amebiasis, inflammatory bowel disease, celiac disease, and vitamin B₁₂ deficiency.

bubble_chart Treatment Measures

First, provide a nutrient-rich diet, appropriate fluid supplementation, and correct electrolyte imbalance. For those with excessive diarrhea, administer antidiarrheal agents. Vitamin B₁₂ and folic acid treatment should continue for one year. Concurrently, administer antibiotic therapy, such as oral tetracycline 250–500mg, 4 times daily for one month, then reduce to twice daily for 5–6 months. Sulfonamides are also effective; for example, succinylsulfathiazole (sulfasuxidine) 1.0g, 4 times daily orally for one month, then reduced to twice daily for five months. After treatment, anemia and glossitis improve rapidly, appetite improves, weight increases, and intestinal mucosal lesions show improvement, with increased enzyme activity in the intestinal mucosa. Some cases respond slowly to treatment, with symptoms and malabsorption persisting for an extended period, thus requiring prolonged therapy.