Distinguishing tropical sprue from celiac disease in returning travellers with chronic diarrhoea: a diagnostic challenge?
BACKGROUND
Within the present era of worldwide travel, it is important for all clinicians to consider the possibility of tropical sprue (TS) in returning patients with persistent diarrhoea after travel. The symptoms and histologic findings of TS can resemble but also be confused with celiac disease (CD).


MATERIAL AND METHOD
Patients at our institute diagnosed with CD or TS in the period January 2000-December 2010 were eligible for inclusion. Of all patients, demographic, clinical, laboratory and endoscopy data on admission and in follow-up were collected retrospectively.


RESULTS
28 CD and 7 TS patients were included. There were no differences in baseline clinical characteristics, duration of stay in a tropical region or in laboratory findings on admission. However, in the majority of CD patients antibodies against endomysium (EMA) or tissue transglutaminase (tTG) were present at presentation but absent in all TS patients at presentation.


CONCLUSIONS
In returning travellers with persistent diarrhoea, a diagnosis of CD is unlikely in case of absence of anti-EMA or anti-tTG antibodies but conversely increases the likelihood of TS. This distinct immunoserological profile may be of help in selecting the optimal treatment in returning travelers with chronic diarrhoea after staying in a tropical region.
['Langenberg|Marijke C C|MC|', 'Wismans|Pieter J|PJ|', 'van Genderen|Perry J J|PJ|']
D000293:Adolescent D000328:Adult D000368:Aged D002446:Celiac Disease D002908:Chronic Disease D003967:Diarrhea D005260:Female D006801:Humans D007413:Intestinal Mucosa D007421:Intestine, Small D008297:Male D008875:Middle Aged D012189:Retrospective Studies D013182:Sprue, Tropical D014195:Travel D055815:Young Adult
Sprue Celiac disease Traveller Diarrhoea