Louis-Auguste John, Kelly Paul
Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, Newark Street, London, E1 2AT, UK.
TROPGAN, University of Zambia School of Medicine, University Teaching Hospital, Lusaka, Zambia.
Curr Gastroenterol Rep. 2017 Jul;19(7):29. doi: 10.1007/s11894-017-0570-0.
The term 'tropical enteropathy' originated in observations in the 1960s that small intestinal morphology and function differed in the tropics from the norms found in temperate climates. It was subsequently shown that this enteropathy is more closely related to environmental conditions than latitude, and it was re-labelled 'environmental enteropathy'. It is now recognised that environmental enteropathy (also now called environmental enteric dysfunction) has implications for the health and linear growth of children in low- and middle-income countries, and it may underlie poor responses to oral vaccination in these countries. The purpose of this review is to define and clarify this enteropathy despite the confusing terminology it has attracted and to contrast it with other enteropathic states.
Recent work has begun to demonstrate the nature of the mucosal lesion and the relationship with microbial translocation which is currently thought to link a failure of mucosal barrier function and the cascade of systemic inflammation which inhibits growth. The evidence is still correlative rather than definitive, but derives some additional support from animal models. There are some common features between environmental enteropathy and other enteropathies, but there are important differences also. The mechanism of the link between enteropathy and vaccine failure is not understood, and neither is it clear how the more severe form of enteropathy, which we refer to as malnutrition enteropathy, is driven by nutrient depletion and intestinal infection. Tropical enteropathies form a group of disorders which include environmental and nutritional enteropathies. The long-term health implications of these disorders for health in low-income countries are just being explored, but the scale of their effects is very large, with millions of people affected.
“热带肠病”这一术语起源于20世纪60年代的观察结果，即热带地区小肠的形态和功能与温带地区的正常情况不同。随后发现，这种肠病与环境条件的关系比与纬度的关系更为密切，因此被重新命名为“环境性肠病”。现在人们认识到，环境性肠病（现也称为环境性肠功能障碍）对低收入和中等收入国家儿童的健康和线性生长有影响，并且可能是这些国家口服疫苗反应不佳的潜在原因。本综述的目的是尽管该肠病有令人困惑的术语，但仍对其进行定义和阐明，并将其与其他肠病状态进行对比。
最近的研究已开始揭示黏膜病变的本质以及与微生物易位的关系，目前认为微生物易位与黏膜屏障功能障碍以及抑制生长的全身炎症级联反应有关。证据仍然是相关性的而非确定性的，但从动物模型中获得了一些额外支持。环境性肠病与其他肠病有一些共同特征，但也存在重要差异。肠病与疫苗接种失败之间联系的机制尚不清楚，同样不清楚我们所说的更严重形式的肠病，即营养不良性肠病，是如何由营养缺乏和肠道感染驱动的。热带肠病是一组疾病，包括环境性和营养性肠病。这些疾病对低收入国家健康的长期影响刚刚开始被探索，但其影响规模非常大，数百万人受到影响。
