Sprue tropical

Sprue tropical (tropical diarrhea) - a serious chronic disease characterized by inflammatory-atrophic changes in the mucous membrane, persistent diarrhea, glossitis and normochromic anemia; Is widespread in countries with a tropical and subtropical climate; in the Soviet Union it occurs in Central Asia and the Caucasus, very rarely among the inhabitants of the middle belt. Women are more often ill, especially during pregnancy, and the elderly.

Etiology and pathogenesis are not well understood. The development of the disease is predisposed to inadequate nutrition (mainly plant food), insufficient intake of protein, vitamin deficiency, severe infectious diseases, previous bacterial and protozoal enterocolitis, weakening and exhaustion of the body, endocrine dysfunctions (during lactation in women, extinction of sexual function), nervously -psychic overvoltage. The lack of vitamins in the food, aggravated by a violation of their absorption in the intestines, contributes to the appearance of dystrophic changes in the internal organs, and deficiency of folic acid and vitamin B12 - the development of anemia.

Symptoms, course. The disease begins with indeterminate dyspeptic complaints, sensations of rumbling, transfusion in the abdomen, flatulence, burning sensation in the tongue. Then persistent diarrhea appears; Stools are liquid, foamy, whitish in color (from the large content of undigested fat). When involved in the process of the distal departments of the colon, tenesmus joins; Feces contain an admixture of mucus and pus. Patients lose weight, there are signs of polyhypovitaminosis. Skin is dry, hyperpigmented, abdomen sharply swollen, percussion over it is determined by a loud tympanic sound. Characterized by erosive-ulcerative glossitis; Gradually papillae of the tongue atrophy, the tongue becomes smooth, shiny ("lacquer tongue").

Laboratory tests reveal anemia (normo- or hyperchromic), hypoproteinemia. Cal has an acid reaction, it determines a large number of drops of undigested fat, crystals of fatty acids, soaps, muscle fibers, undigested cellulose. When X-ray examination - smoothed relief of the mucous membrane and a sharply accelerated passage of contrasting suspension in the intestine; Sometimes horizontal levels of fluid and gas accumulations in intestinal loops are determined. Endoscopic examination and biopsy of the mucous membrane of the stomach, duodenum, and colon confirm the presence of inflammatory-atrophic changes in the digestive organs.

The course is slowly progressing with periods of remission and exacerbation. In the initial stages it is possible to achieve recovery of the patient, in advanced cases the forecast is poor; A common cause of death is general exhaustion.

Differential diagnosis is carried out with amoebiasis, dysentery, banal forms of enterocolitis. Hyperchromic anemia in some cases can cause difficulties in differential diagnosis with B12-deficiency anemia; However, the presence of diarrhea, biopsy data of the mucous membranes of the digestive tract allow you to make the correct diagnosis.

Treatment in the period of exacerbation of the disease and expressed manifestations of the syndrome of malnutrition are carried out in the hospital. Assign a diet with some restriction of fats (pork, lamb) and carbohydrates, increased protein (140-160 g) and vitamins. The food should be well mechanically processed (mashed, rolled through a meat grinder, etc.), cooked for steaming. The food is fractional 4-5 times a day. In addition, parenteral and oral appoint vitamins, especially in high doses (up to 200-300 mg / day) - folic acid. In severe cases, anabolic steroid hormones and glucocorticosteroids are recommended. Sores in the mouth are treated with 2% sodium tetraborate solution and other antiseptic and astringent agents. In cases where the disease is difficult to treat, it is useful to move to places with a cooler climate.