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Sprue or tropical stomatitis

Sprue or tropical stomatitis is a rare disorder , of which the specific causes are unknown . What is known is that it affects people who live or visit the tropical or subtropical zones for long periods. Hence the name of the disease.

Suspicions suggest that it is an infectious disease, although it has not yet been confirmed. The most commonly accepted is that immunological and environmental factors combine in this disease. What has been advanced is the definition of its symptoms and the establishment of mechanisms to formulate the diagnosis.

Sprue or tropical stomatitis is present especially in the Caribbean area , Southeast Asia and southern India . All people who live in these regions, or who travel there and stay for more than a month, have the risk of contracting the disease. It is very rare that it affects children. During the last decades incidence of this evil has been decreasing.

Generalities of the disease

Sprue or tropical stomatitis

Sprue is a disease that has been known for approximately 2,000 years. However, it was only in 1759 that Wiliam Hillary described it in Barbados. However, it only differed from celiac disease until well into the 20th century . In fact, many aspects of this disease are still unknown today.

Sprue is defined as a SAID, that is, as a Syndrome of Intestinal Absorption Deficient . What characterizes this disease is that it causes a flattening of the intestinal villi.

It also causes inflammation in the lining of the small intestine. All this causes the absorption of nutrients in the intestine to be altered.

The most problematic of this disease is that it prevents the correct absorption of fundamental elements, such as folic acid and vitamin B12. This leads to megalopathic anemia. The malabsorption of iron leads to iron-deficiency anemia. It must be said that the general definition of sprue is not universally accepted.

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Causes and symptoms of sprue

Sprue or tropical stomatitis

The exact cause of the disease is unknown, but there are reasons to believe that it is an infectious type. Many toxin-producing bacteria, such as Klebsiella pneumoniae , E. coli and E. cloacae , have been found in many patients with this disease.

Likewise, many patients improve when they are given antibiotics. This would corroborate the infection hypothesis.

It is also suspected that it could be a sequel to acute infectious diarrhea . This would give rise to the contamination of the intestine and the appearance of sprue. The imprecision of all these data is what leads to define sprue as a syndrome.

Typical symptoms of sprue include:

  • Stools of light color, soft, abundant and greasy
  • Fever and malaise
  • Anorexia, gas and abdominal cramps
  • Swelling in the legs
  • Night blindness in some cases
  • Weightloss

The poor absorption of nutrients causes in many cases associated anemia. This, in turn, gives rise to new symptoms such as sores in the tongue, due to vitamin B2 deficiency. Also fatigue and weakness, when there is deficiency of folate or vitamin B12.

It is also possible that glositis, stomatitis and peripheral edema appear. Sometimes, symptoms appear many years after visiting a tropical.

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Diagnosis and prognosis

Sprue or tropical stomatitis

When a person lives or has visited any of the risk areas and has anemia or malabsorption of nutrients, the doctor will consider a diagnosis of tropical sprue. The most frequent and reliable method to corroborate the suspicion is a biopsy .

A sample of tissue is removed from the small intestine in the biopsy . For this, an endoscope is used, which is a flexible tube, equipped with light and a small camera. A clamp can be inserted into this device to take the sample. This is examined under a microscope.

Usually, blood tests and stool tests are also done . The first one allows to determine if there is malnutrition and what are the precise effects of the malabsorption of nutrients. The stool test allows to rule out or corroborate the presence of parasites and other microorganisms.

The prognosis of sprue is encouraging. In general, it refers without problems when the treatment is applied . Although it rarely occurs in children, to do so may cause growth retardation and bone maturation.

Sprue or tropical stomatitis

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