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In the late stages of the disease, there is decrease in the space between two adjacent loops of bowel, demonstrating the thinning of the entire wall of the intestine caused by atrophy, which is confirmed by autopsy findings. Peroral biopsy should not be attempted when this radiological finding is present, or should be done with due caution.

An overall return of all disease parameters and radiological findings to normal is expected with comprehensive treatment, including control of diarrhea by drugs, correction of fluid and electrolyte imbalance and acidosis, administration of iron, folic acid and vitamin B12, long- term antibiotic therapy with tetracycline, and a high protein diet. If the tropical sprue patient is neglected or untreated, the mortality rate can be as high as 25%.

Differential Diagnosis

A bewildering array of diseases and conditions seen worldwide can cause intestinal malabsorption. (See Table 16.2.) In the tropics especially, malabsorption may be caused or complicated by the presence of one or more parasitic diseases, such as giardiasis, hookworm disease, strongyloidiasis, capillariasis, or schistosomiasis japonica. Interestingly enough, tropical sprue is often somewhat more common in the middle and higher socioeconomic groups than in the impoverished, undernourished citizenry of some countries. The introduction of sophisticated laboratory and radioisotope studies to determine various intestinal absorption patterns and deficiencies, together with the advent of suction biopsy of the small bowel, has helped to distinguish between the many diseases that can cause an intestinal malabsorption syndrome. It must be kept constantly in mind that tropical sprue is but one of many causes of malabsorption in the tropics and that there are still many riddles to be solved regarding this mysterious and intriguing disease, not the least of which is its pathogenesis.

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Copyright: Palmer and Reeder

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