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[PMID]:28513629
[Au] Autor:Ghoshal UC; Gwee KA
[Ad] Endereço:Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
[Ti] Título:Post-infectious IBS, tropical sprue and small intestinal bacterial overgrowth: the missing link.
[So] Source:Nat Rev Gastroenterol Hepatol;14(7):435-441, 2017 Jul.
[Is] ISSN:1759-5053
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Evidence is emerging that IBS, a hitherto enigmatic disorder thought to be predominantly related to psychological factors, has a microorganic basis in a subset of patients with the disease. Post-infectious IBS (PI-IBS), commonly of the diarrhoea-predominant subtype (defined as new development of IBS following acute infectious diarrhoea), is one such condition known to occur in up to 10-30% individuals after acute gastroenteritis. However, following acute infectious gastroenteritis, patients can also develop post-infectious malabsorption syndrome (PI-MAS), popularly known as tropical sprue. As no study on PI-IBS has rigorously excluded tropical sprue by appropriate investigations, including small intestinal biopsy, the frequency of tropical sprue among patients with PI-IBS is not known. Small intestinal bacterial overgrowth (SIBO) has been suggested to be associated with IBS in general, and in particular diarrhoea-predominant IBS, including PI-IBS. SIBO is also known to be associated with tropical sprue. As both IBS, particularly the subset probably associated with SIBO, and tropical sprue improve with antibiotic treatment, we provide evidence and an explanatory model to support a link among these disorders.
[Mh] Termos MeSH primário: Síndrome da Alça Cega/microbiologia
Síndrome do Intestino Irritável/microbiologia
Espru Tropical/microbiologia
[Mh] Termos MeSH secundário: Doença Aguda
Infecções Bacterianas/complicações
Síndrome da Alça Cega/complicações
Gastroenterite/complicações
Seres Humanos
Intestino Delgado/microbiologia
Síndrome do Intestino Irritável/complicações
Espru Tropical/complicações
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170814
[Lr] Data última revisão:
170814
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170518
[St] Status:MEDLINE
[do] DOI:10.1038/nrgastro.2017.37


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[PMID]:26496241
[Au] Autor:Hanif FM; Luck NH; Abbas Z; Aziz T; Hassan SM; Mubarak M
[Ad] Endereço:From the Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
[Ti] Título:Prevalence and Characteristics of Duodenal Villous Atrophy in Renal Transplant Patients Presenting With Persistent Diarrhea in a Developing Country.
[So] Source:Exp Clin Transplant;14(2):146-52, 2016 Apr.
[Is] ISSN:2146-8427
[Cp] País de publicação:Turkey
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Persistent diarrhea is a common complication after solid-organ transplant, including kidney transplant. Data on duodenal villous atrophy as a cause of persistent diarrhea in renal transplant recipients are scarce. MATERIALS AND METHODS: We conducted a prospective analysis of 207 patients who received renal transplants from 2009 to 2012 with persistent diarrhea and who underwent upper gastrointestinal endoscopy and duodenal biopsies. Duodenal biopsies were examined for duodenal villous atrophy. Age, sex, transplant duration, and drugs were compared between patients with and without duodenal villous atrophy. After exclusion of known causes of duodenal villous atrophy, a 3-month course of antibiotics was given and outcomes were analyzed. RESULTS: Of 207 renal transplant recipients, 104 patients (49.8%) displayed duodenal villous atrophy. Of these, 92 (88.5%) were male patients. The mean age of patients with duodenal villous atrophy was 34.9 ± 10.3 years. The mean onset of persistent diarrhea in DVA-positive patients posttransplant was 2.16 ± 0.8 years. Celiac disease serology was positive in 18 (17.3) patients. Giardiasis was demonstrated in 11 patients (10.7%), whereas immunoproliferative small intestinal disease was shown in 7 patients (6.8%). The remaining 68 patients (65.38%) received antibiotics, with 50 recipients (74.6%) showing complete response, although 13 of these patients (26%) relapsed. Among the remaining 18 patients (26.47%), 9 (50%) had other causes and 9 (50%) had no cause found. Isoniazid prophylaxis showed statistically significant negative association with duodenal villous atrophy. CONCLUSIONS: Duodenal villous atrophy is highly prevalent in renal transplant recipients irrespective of age, sex, and posttransplant duration. We found tropical sprue, giardiasis, immunoproliferative small intestinal disease, and celiac disease to be important causes of duodenal villous atrophy. Therefore, duodenal biopsy is recommended in renal transplant recipients with persistent diarrhea.
[Mh] Termos MeSH primário: Doença Celíaca/epidemiologia
Países em Desenvolvimento
Diarreia/epidemiologia
Duodeno/patologia
Giardíase/epidemiologia
Doença Imunoproliferativa do Intestino Delgado/epidemiologia
Transplante de Rim/efeitos adversos
Espru Tropical/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Atrofia
Biópsia
Doença Celíaca/diagnóstico
Doença Celíaca/patologia
Doença Celíaca/terapia
Diarreia/diagnóstico
Diarreia/terapia
Feminino
Giardíase/diagnóstico
Giardíase/patologia
Giardíase/terapia
Seres Humanos
Doença Imunoproliferativa do Intestino Delgado/diagnóstico
Doença Imunoproliferativa do Intestino Delgado/patologia
Doença Imunoproliferativa do Intestino Delgado/terapia
Masculino
Meia-Idade
Paquistão/epidemiologia
Valor Preditivo dos Testes
Prevalência
Estudos Prospectivos
Espru Tropical/diagnóstico
Espru Tropical/patologia
Espru Tropical/terapia
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1612
[Cu] Atualização por classe:161230
[Lr] Data última revisão:
161230
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:151027
[St] Status:MEDLINE
[do] DOI:10.6002/ect.2015.0183


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[PMID]:26115751
[Au] Autor:McCarroll MG; Riddle MS; Gutierrez RL; Porter CK
[Ad] Endereço:Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, 20037, USA.
[Ti] Título:Infectious Gastroenteritis as a Risk Factor for Tropical Sprue and Malabsorption: A Case-Control Study.
[So] Source:Dig Dis Sci;60(11):3379-85, 2015 Nov.
[Is] ISSN:1573-2568
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Previous studies have linked an increase in functional and pathological gastrointestinal (GI) disorders following antecedent infectious gastroenteritis (IGE), yet studies of other chronic GI disorders such as tropical sprue (TS) and intestinal malabsorption (IM) are lacking. This study was performed to evaluate the association between documented IGE and the risk of TS and IM using a matched case-control study. METHODS: The odds of IGE (exposure) among subjects with TS and IM were compared to the odds of exposure in matched controls. Data were obtained from the Defense Medical Surveillance System. Incidence was estimated based on the number of active duty military personnel, and conditional logistic regression models were used to evaluate the relationship between IGE and TS/IM while adjusting for potential confounders. RESULTS: The overall incidence of TS and IM was 0.24 and 1.98 per 100,000 person-years, respectively. After adjusting for important covariates, prior IGE was associated with an increase in the odds of TS (odds ratio (OR) 36.64) and IM (OR 3.93) (p < 0.001). Other covariates demonstrating an increased risk were being of Caucasian race, having greater than high school education, and service in military branches other than the Army. CONCLUSION: Overall, this study demonstrates the first significant estimates that a case of antecedent IGE is associated with an increased risk of TS and IM in an active duty military population. Ultimately, acquisition of TS or IM has the potential to decrease operational efficiency, which may have a significant impact on deployed military missions.
[Mh] Termos MeSH primário: Disenteria/epidemiologia
Síndromes de Malabsorção/epidemiologia
Medicina Militar
Espru Tropical/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Estudos de Casos e Controles
Disenteria/diagnóstico
Feminino
Seres Humanos
Incidência
Modelos Logísticos
Síndromes de Malabsorção/diagnóstico
Masculino
Militares
Análise Multivariada
Razão de Chances
Fatores de Risco
Espru Tropical/diagnóstico
Fatores de Tempo
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1602
[Cu] Atualização por classe:171019
[Lr] Data última revisão:
171019
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:150628
[St] Status:MEDLINE
[do] DOI:10.1007/s10620-015-3768-8


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[PMID]:25821865
[Au] Autor:Schumann M; Daum S; Preiss JC; Baas S; Stallmach A; Siegmund B; Weber M
[Ti] Título:[Rare diseases on the trail--the registry for refractory sprue].
[Ti] Título:Seltenen Erkrankungen auf der Spur ­das Register für Refraktäre Sprue..
[So] Source:Z Gastroenterol;53(2):136, 2015 Feb.
[Is] ISSN:1439-7803
[Cp] País de publicação:Germany
[La] Idioma:ger
[Mh] Termos MeSH primário: Espru Tropical/diagnóstico
Espru Tropical/epidemiologia
[Mh] Termos MeSH secundário: Doença Crônica
Alemanha/epidemiologia
Seres Humanos
Incidência
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1511
[Cu] Atualização por classe:150327
[Lr] Data última revisão:
150327
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150331
[St] Status:MEDLINE


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[PMID]:25603404
[Au] Autor:Bourke B; Hussey S
[Ad] Endereço:aNational Centre for Paediatric Gastroenterology, Our Lady's Children's Hospital bNational Children's Research Centre, Crumlin, Dublin cUCD School of Medicine and Medical Science dConway Institute, University College Dublin, Belfield, Dublin, Ireland.
[Ti] Título:Chronic infections of the small intestine.
[So] Source:Curr Opin Gastroenterol;31(2):104-10, 2015 Mar.
[Is] ISSN:1531-7056
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE OF REVIEW: Chronic infections of the small intestine cause significant morbidity and mortality globally. This review focuses on the recent advances in the field of our understanding of selected intestinal infections. RECENT FINDINGS: Primary and secondary immunodeficiency increase the susceptibility to many chronic intestinal infections. Endoscopy and intestinal biopsies are central to establishing a diagnosis of these conditions. Tuberculosis (TB) remains a major global health challenge. Emerging therapeutic agents to counteract multidrug-resistant strains have shown clinical efficacy, but concerns regarding mortality remain. PCR-based diagnostic TB tests have the potential to reduce diagnostic delays, but remain to be validated for intestinal infections. Adjunctive diagnostic imaging modalities can differentiate infections from Crohn's disease with increasing accuracy. Whipple's disease remains rare, but there have been substantial advances in our understanding of the causative organism Tropheryma whipplei. Extended treatment with broad-spectrum antibiotics is effective in most cases. The narrow therapeutic window and limited armamentarium for treating invasive filamentous fungal infections contribute to their significant morbidity and high rates of mortality. SUMMARY: The speed and accuracy of diagnosing chronic intestinal infections have improved with recent imaging and laboratory methodologies. Significant research opportunities remain for clinicians and scientists to improve the diagnostic accuracy and clinical outcomes of chronic intestinal infections.
[Mh] Termos MeSH primário: Antibacterianos/uso terapêutico
Gastroenterite/diagnóstico
Hospedeiro Imunocomprometido
Intestino Delgado/imunologia
[Mh] Termos MeSH secundário: Aspergilose/diagnóstico
Aspergilose/tratamento farmacológico
Aspergilose/imunologia
Candidíase/diagnóstico
Candidíase/tratamento farmacológico
Candidíase/imunologia
Doença de Crohn/diagnóstico
Doença de Crohn/tratamento farmacológico
Doença de Crohn/imunologia
Gastroenterite/tratamento farmacológico
Gastroenterite/imunologia
Seres Humanos
Intestino Delgado/patologia
Mucormicose/diagnóstico
Mucormicose/tratamento farmacológico
Mucormicose/imunologia
Reação em Cadeia da Polimerase
Espru Tropical/diagnóstico
Espru Tropical/tratamento farmacológico
Espru Tropical/imunologia
Tuberculose Gastrointestinal/diagnóstico
Tuberculose Gastrointestinal/tratamento farmacológico
Tuberculose Gastrointestinal/imunologia
Doença de Whipple/diagnóstico
Doença de Whipple/tratamento farmacológico
Doença de Whipple/imunologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1511
[Cu] Atualização por classe:150204
[Lr] Data última revisão:
150204
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150121
[St] Status:MEDLINE
[do] DOI:10.1097/MOG.0000000000000153


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[PMID]:25234408
[Au] Autor:Greenson JK
[Ad] Endereço:University of Michigan Medical Center, Ann Arbor, MI, USA.
[Ti] Título:The biopsy pathology of non-coeliac enteropathy.
[So] Source:Histopathology;66(1):29-36, 2015 Jan.
[Is] ISSN:1365-2559
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Tropical sprue (TS) is a malabsorption syndrome of presumed infectious aetiology that affects residents of (or visitors to) the tropics. The histological changes of TS are similar to those of coeliac disease, with increased intraepithelial lymphocytes being central to both. Unlike in coeliac disease, however, a completely flat small bowel biopsy is uncommon in TS. TS typically involves the terminal ileum, whereas coeliac disease does not. Small intestinal bacterial overgrowth (SIBO) has been defined as an increase in number and/or a change in the type of bacteria in the upper gut. Conditions that predispose to SIBO are largely those that decrease or interfere with small bowel motility. The mucosal histology is variable, and may include modest villous blunting accompanied by increased lamina propria and epithelial inflammation. Autoimmune enteropathy (AE) is a family of rare diseases that share common themes such as immunodeficiency states and autoantibodies. AE cases typically have marked villous atrophy similar to that in fully developed coeliac disease, but they lack the intense surface epithelial lymphocytosis. Apoptosis and lymphocyte infiltration at the base of the crypts, crypt abscesses and cryptitis are also seen. Patients with anti-goblet cell antibodies can have a lack of goblet cells, endocrine cells, and Paneth cells.
[Mh] Termos MeSH primário: Síndrome da Alça Cega/patologia
Intestino Delgado/patologia
Poliendocrinopatias Autoimunes/patologia
Espru Tropical/patologia
[Mh] Termos MeSH secundário: Biópsia
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1509
[Cu] Atualização por classe:150202
[Lr] Data última revisão:
150202
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140920
[St] Status:MEDLINE
[do] DOI:10.1111/his.12522


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[PMID]:24889052
[Au] Autor:Langenberg MC; Wismans PJ; van Genderen PJ
[Ad] Endereço:Institute for Tropical Diseases, Department of Internal Medicine, Harbour Hospital Rotterdam, Haringvliet 2, 3011 TD Rotterdam, The Netherlands. Electronic address: mcclangenberg@gmail.com.
[Ti] Título:Distinguishing tropical sprue from celiac disease in returning travellers with chronic diarrhoea: a diagnostic challenge?
[So] Source:Travel Med Infect Dis;12(4):401-5, 2014 Jul-Aug.
[Is] ISSN:1873-0442
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Within the present era of worldwide travel, it is important for all clinicians to consider the possibility of tropical sprue (TS) in returning patients with persistent diarrhoea after travel. The symptoms and histologic findings of TS can resemble but also be confused with celiac disease (CD). MATERIAL AND METHOD: Patients at our institute diagnosed with CD or TS in the period January 2000-December 2010 were eligible for inclusion. Of all patients, demographic, clinical, laboratory and endoscopy data on admission and in follow-up were collected retrospectively. RESULTS: 28 CD and 7 TS patients were included. There were no differences in baseline clinical characteristics, duration of stay in a tropical region or in laboratory findings on admission. However, in the majority of CD patients antibodies against endomysium (EMA) or tissue transglutaminase (tTG) were present at presentation but absent in all TS patients at presentation. CONCLUSIONS: In returning travellers with persistent diarrhoea, a diagnosis of CD is unlikely in case of absence of anti-EMA or anti-tTG antibodies but conversely increases the likelihood of TS. This distinct immunoserological profile may be of help in selecting the optimal treatment in returning travelers with chronic diarrhoea after staying in a tropical region.
[Mh] Termos MeSH primário: Doença Celíaca/diagnóstico
Diarreia/complicações
Espru Tropical/diagnóstico
Viagem
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Doença Celíaca/complicações
Doença Celíaca/epidemiologia
Doença Celíaca/patologia
Doença Crônica
Diarreia/epidemiologia
Feminino
Seres Humanos
Mucosa Intestinal/patologia
Intestino Delgado/patologia
Masculino
Meia-Idade
Estudos Retrospectivos
Espru Tropical/complicações
Espru Tropical/epidemiologia
Espru Tropical/patologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1503
[Cu] Atualização por classe:140805
[Lr] Data última revisão:
140805
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140604
[St] Status:MEDLINE


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[PMID]:24781741
[Au] Autor:Ghoshal UC; Srivastava D; Verma A; Ghoshal U
[Ad] Endereço:Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014, India, udayghoshal@gmail.com.
[Ti] Título:Tropical sprue in 2014: the new face of an old disease.
[So] Source:Curr Gastroenterol Rep;16(6):391, 2014.
[Is] ISSN:1534-312X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Tropical sprue (TS), once known to be a common cause of malabsorption syndrome (MAS) in India and other tropical countries, is believed to be uncommon currently in spite of contrary evidence. Several recent studies from India showed TS to be the commonest cause of sporadic MAS in Indian adults. TS is diagnosed in patients presenting with suggestive clinical presentation, which cannot be explained by another cause of MAS and investigations revealing malabsorption of two unrelated substances, abnormal small-intestinal mucosal histology, which responds to treatment with antibiotics such as tetracycline and folic acid. There is substantial overlap between TS and postinfectious irritable bowel syndrome. There have been several advances in epidemiology, pathogenesis, and diagnosis of TS, hitherto an enigmatic condition.
[Mh] Termos MeSH primário: Espru Tropical/diagnóstico
[Mh] Termos MeSH secundário: Bactérias/crescimento & desenvolvimento
Diagnóstico Diferencial
Gastroenterite/complicações
Seres Humanos
Intestino Delgado/microbiologia
Síndrome do Intestino Irritável/diagnóstico
Síndrome do Intestino Irritável/microbiologia
Espru Tropical/tratamento farmacológico
Espru Tropical/epidemiologia
Espru Tropical/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1412
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140501
[St] Status:MEDLINE
[do] DOI:10.1007/s11894-014-0391-3


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[PMID]:24629612
[Au] Autor:Hvattum SA; Schaffalitzky de Muckadell OB
[Ad] Endereço:Medicinsk Gastroenterologisk Afdeling S, Odense Universitetshospital, Sdr. Boulevard 29, 5000 Odense. stineah@gmail.com.
[Ti] Título:[Tropical sprue as a differential diagnosis to coeliac disease in a patient on immunosuppressive medication].
[Ti] Título:Tropisk sprue som differentialdiagnose til cøliaki hos patient i immunsupprimerende behandling..
[So] Source:Ugeskr Laeger;176(1):62-3, 2014 Jan 06.
[Is] ISSN:1603-6824
[Cp] País de publicação:Denmark
[La] Idioma:dan
[Ab] Resumo:A Danish woman who was on immunosuppressive medication due to a previous liver transplantation travelled to Indonesia for three weeks. After returning she developed nonfebrile severe, watery diarrhoea, dehydration and malnutrition. A thorough examination revealed small intestine changes, which were compatible with coeliac disease. However, the HLA-type and the serology did not support this diagnosis. Treatment for tropical sprue was initiated, resulting in complete remission. Tropical sprue is suggested to be an infectious disease. It is usually seen in people with prolonged stay in tropical areas, but this patient's medication may have predisposed her.
[Mh] Termos MeSH primário: Espru Tropical/diagnóstico
[Mh] Termos MeSH secundário: Idoso
Doença Celíaca/diagnóstico
Diagnóstico Diferencial
Duodeno/patologia
Feminino
Seres Humanos
Imunossupressão/efeitos adversos
Indonésia
Mucosa Intestinal/patologia
Espru Tropical/tratamento farmacológico
Espru Tropical/patologia
Viagem
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1607
[Cu] Atualização por classe:161125
[Lr] Data última revisão:
161125
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140318
[St] Status:MEDLINE


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[PMID]:24441659
[Au] Autor:Brown IS; Bettington A; Bettington M; Rosty C
[Ad] Endereço:*Envoi Specialist Pathologists †Anatomical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital §The Conjoint Gastroenterology Laboratory ¶Cancer and Population Studies Group, Queensland Institute of Medical Research, Bancroft Centre ∥School of Medicine, University of Queensland, Herston ‡Sullivan Nicolaides Pathology, Taringa, QLD, Australia.
[Ti] Título:Tropical sprue: revisiting an underrecognized disease.
[So] Source:Am J Surg Pathol;38(5):666-72, 2014 May.
[Is] ISSN:1532-0979
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Tropical sprue is an acquired chronic diarrheal disorder of unclear etiology affecting residents of and visitors to tropical regions. Patients usually present with profuse diarrhea, weight loss, and malabsorption, notably of vitamin B12 and folate. The histologic changes typically resemble that of gluten-sensitive enteropathy. Reports of tropical sprue have become infrequent in the literature, and the diagnosis is often not considered either clinically or pathologically. This disease may, however, cause significant morbidity, although it is eminently treatable with broad-spectrum antibiotics. In this study, we report the clinical presentation of 12 tropical sprue patients along with the histologic changes of the intestinal mucosa and compare it with those of a series of 150 cases of gluten-sensitive enteropathy, the condition with which it is most frequently misdiagnosed. The cohort comprised 6 men and 6 women with a median age of 59 years (range, 38 to 78 y) with a history of residence or visitation in South Asia or Papua New Guinea. Partial villous blunting in the duodenal mucosa was present in 75% of cases, and a marked intraepithelial lymphocytosis was observed in all cases (mean per 100 epithelial cells 77.3; range, 42 to 124). A villous tip accentuation of intraepithelial lymphocytosis was not appreciable in most cases. No case of complete villous blunting (Marsh stage 3c) was identified in tropical sprue, contrasting with 25% in gluten-sensitive enteropathy cases. A duodenal mucosa eosinophil infiltrate was present in all cases with significantly higher counts compared with untreated gluten-sensitive enteropathy patients (26.6/HPF vs. 14.6/HPF; P=0.009). The ileal mucosa displayed more severe villous blunting with higher Marsh stages than in the corresponding duodenum from 5 patients. There was a mild intraepithelial lymphocytosis and eosinophil infiltrate in the colonic mucosa of half of the cases. Follow-up biopsies in 6 patients demonstrated a histologic response after oral folates and doxycycline treatment. In summary, tropical sprue is a pan-enteric inflammatory process often mistaken for gluten-sensitive enteropathy. Histologic findings suggesting tropical sprue in the appropriate clinical context include incomplete duodenal villous blunting without development of flat mucosa, frequent involvement of the terminal ileum with more marked inflammation and villous blunting than in the duodenum, and a conspicuous eosinophil infiltrate in the lamina propria. With the expansion of tourism and increasing employment opportunities in tropical regions, pathologists in the West are increasingly likely to encounter cases of tropical sprue and should be aware of this diagnosis.
[Mh] Termos MeSH primário: Espru Tropical/patologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Doença Celíaca/patologia
Feminino
Seres Humanos
Mucosa Intestinal/patologia
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1405
[Cu] Atualização por classe:140411
[Lr] Data última revisão:
140411
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140121
[St] Status:MEDLINE
[do] DOI:10.1097/PAS.0000000000000153



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BIREME/OPAS/OMS - Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde