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Aetiology and pathogenesis of postinfective tropical malabsorption (tropical sprue)
Abstract:
Postinfective tropical malabsorption (TM; tropical sprue) starts with an acute intestinal infection (bacterial, viral, or parasitic) which can affect predominantly the small or the large intestine. Miscellaneous invasive pathogens cause subsequent enterocyte damage affecting the entire small intestine and, to a lesser extent, the colon. Enteroglucagon, a tropic hormone, is then liberated and reaches a high plasma concentration. Small-intestinal stasis results. Further bacterial colonisation (in the lumen and also at the enterocyte surface) is encouraged. Continuing enterocyte damage is worsened by coexistent folate depletion, which is initiated at the onset of disease; body stores of folate reach a low concentration by 3 or 4 months. The cycle continues until the bacterial overgrowth is eliminated with an antibiotic (eg, tetracycline), or mucosal integrity recovers (hastened by oral folic-acid supplements), or both.
Insights
Postinfective tropical malabsorption, or tropical sprue, involves intestinal damage and bacterial overgrowth. Treatment with antibiotics and folic acid can break this cycle.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Nutritional Science
Background:
- Postinfective tropical malabsorption (TM), also known as tropical sprue, is initiated by acute intestinal infections.
- Pathogens cause enterocyte damage, primarily in the small intestine, leading to hormonal changes and stasis.
- Bacterial colonization and folate depletion exacerbate the condition, creating a persistent cycle of damage.
Purpose of the Study:
- To describe the pathophysiology of postinfective tropical malabsorption.
- To elucidate the factors contributing to the chronicity of the disease.
- To identify potential therapeutic interventions.
Main Methods:
- The study describes the pathological cascade following an initial intestinal infection.
- It details the roles of enterocyte damage, enteroglucagon, small-intestinal stasis, and bacterial overgrowth.
- Folate depletion's contribution to the disease cycle is also discussed.
Main Results:
- Acute intestinal infections trigger enterocyte damage and subsequent hormonal imbalances.
- Small-intestinal stasis promotes bacterial colonization, worsening enterocyte damage.
- Concurrent folate depletion significantly contributes to the disease's progression and persistence.
Conclusions:
- Tropical sprue is a complex condition involving infection, malabsorption, bacterial overgrowth, and nutritional deficiencies.
- Eliminating bacterial overgrowth with antibiotics and restoring folate levels are key to recovery.
- Understanding this cycle is crucial for effective management and treatment strategies.