Westergaard Henrik
Division of Digestive and Liver Diseases, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
Curr Treat Options Gastroenterol. 2004 Feb;7(1):7-11. doi: 10.1007/s11938-004-0020-6.
Tropical sprue is a disease that causes progressive villus atrophy in the small intestine, similar to nontropical (celiac) sprue. The loss of intestinal villi profoundly affects intestinal absorptive function, and patients with tropical or nontropical sprue present with malabsorption. Whereas the etiology of celiac sprue has been elucidated in considerable detail, the etiology of tropical sprue remains obscure. The favored hypothesis is that the disease is either initiated or sustained by a still-undefined infection. Patients with tropical sprue typically present with macrocytic anemia due to malabsorption of folate and/or vitamin B(12). Treatment of tropical sprue with folic acid replacement was introduced more than 50 years ago and has become standard medical treatment. Vitamin B(12) replacement is usually added if there is evidence of B(12) deficiency or malabsorption. Treatment of tropical sprue with folate and B(12) cures the macrocytic anemia and the accompanying glossitis, and often results in increased appetite and weight gain. However, even prolonged treatment with these vitamins fails to restore villus atrophy, and malabsorption usually persists. The benefit of antibiotic treatment of tropical sprue was first documented during World War II, when sulfonamides were used to treat epidemics of tropical sprue in British and Italian troops in India. Antibiotic treatment has since become the standard treatment, and tetracycline has replaced sulfonamides. The recommended length of treatment with tetracycline is 6 months and it is given in combination with folate. The treatment has been shown to normalize mucosal structure in the small intestine and resolve malabsorption in most patients with tropical sprue. However, there is a substantial relapse rate in treated patients who return to, or remain in, endemic areas in the tropics.
热带口炎性腹泻是一种导致小肠绒毛进行性萎缩的疾病，类似于非热带（乳糜泻）口炎性腹泻。肠绒毛的丧失严重影响肠道吸收功能，热带或非热带口炎性腹泻患者会出现吸收不良。虽然乳糜泻的病因已得到相当详细的阐明，但热带口炎性腹泻的病因仍不明确。最受青睐的假说是，该疾病由一种尚未明确的感染引发或持续存在。热带口炎性腹泻患者通常因叶酸和/或维生素B12吸收不良而出现大细胞性贫血。50多年前就开始用叶酸替代疗法治疗热带口炎性腹泻，现已成为标准的医学治疗方法。如果有维生素B12缺乏或吸收不良的证据，通常会加用维生素B12替代疗法。用叶酸和维生素B12治疗热带口炎性腹泻可治愈大细胞性贫血及伴随的舌炎，且常常会使食欲增加、体重上升。然而，即使长期使用这些维生素治疗也无法恢复绒毛萎缩，吸收不良通常会持续存在。抗生素治疗热带口炎性腹泻的益处最早在第二次世界大战期间得到证实，当时磺胺类药物被用于治疗印度的英国和意大利军队中流行的热带口炎性腹泻。此后，抗生素治疗已成为标准治疗方法，四环素已取代磺胺类药物。推荐的四环素治疗疗程为6个月，并与叶酸联合使用。该治疗方法已被证明可使小肠黏膜结构恢复正常，并使大多数热带口炎性腹泻患者的吸收不良症状得到缓解。然而，回到或留在热带流行地区的接受治疗的患者复发率很高。
