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Question 1

Which of the following statements about tropical sprue (TS) are true?
A. Tropical sprue (TS) is seen only in visitors to the tropics
B. TS does not occur in epidemic form
C. TS has a uniform geographical distribution in all tropical regions
D. Patients can present with nutritional deficiencies in the absence of diarrhea.

Answer 1

D

Question 2

Which of the following statements about TS are true?
A. Bacterial colonization of the small intestine is rare in patients with TS
B. Colonic absorption of water remains unaffected in TS
C. Morphological changes in the mucosa in patients with TS resemble those of celiac disease
D. Small bowel transit is reduced in TS.

Answer 2

C

Question 3

35-year-old woman living in Cairo… developed chronic gastrointestinal symptoms after a trip to India… She continues to have loose, watery stools, bloating, and abdominal pain despite normal investigations and failed gluten-free diet trials.
What is diagnosis?why?

Answer 3

Diagnosis is Tropical sprue
*Why ?
- Chronic diarrhea with malabsorptive features (urgency, bloating)
- History of travel to an endemic region (India)
- Normal stool culture and ova/parasite tests (excludes infections)
- Negative celiac serology and no improvement with gluten-free diet
- Normal colonoscopy and imaging

Question 4

How is the diagnosis made?

Answer 4

How is the diagnosis made?

Tropical sprue is a diagnosis of exclusion, but suggestive tests include:
1. Small bowel biopsy:
Villous atrophy
Inflammatory infiltrate in lamina propria
Similar to celiac, but usually milder
2. Lab findings (supportive):
Low vitamin B12 or folate
Low serum albumin
Evidence of fat malabsorption (e.g., low fecal elastase, positive fecal fat test)
3. Exclusion of other causes:
Celiac disease, IBD, IBS, pancreatic insufficiency, parasitic infections

Question 5

What are the treatment options?

Answer 5

1. Antibiotics (for suspected bacterial overgrowth):
   Tetracycline 250 mg QID for 1–3 months (or doxycycline)
2. Nutritional supplementation:
   Folic acid (often leads to rapid symptom improvement)
   Vitamin B12 if deficient
3. Dietary support:
   High-protein, high-calorie diet

Question 6

Diarrhea +
Travel to endemic(india,porterico,haiti,dominican republic,cuba,middle east)
+ Increase Mcv
+ Oatmeal stool شبه الشوفان

Answer 6

Tropical sprue

Question 7

امتي يبقي في
Chronic form of tropical sprue

Answer 7

لو الشخص قعد غي المنطقة المبوءة اكتر من سنتين
Stages
1- fatigue, abdominal discomfort
2- diarrhea, malabsorption
3- increased mcv