Prognosis of Tropical Sprue

Abstract

This study represents a detailed analysis of the effect of folic acid therapy on the clinical, biochemical, and histological aspects of tropical sprue. Prognosis in the disease was determined by following its course for 3 years in 20 patients with acute sprue and in 26 patients with sprue of 3 to 5 years duration. Each patient was subjected to a series of biochemical tests every 6 months which included D+ xylose, vitamin A tolerance, serum carotene, radioactive Co, vitamin B12 absorption, and a 6 day fecal fat analysis. Histologic appraisal of the small bowel lesion was carried out simultaneously. A good correlation between biochemical, histologic appearance of the intestinal mucosa and the small bowel roentgen examination was found. Although folic acid therapy improved intestinal absorption in the majority of the patients, it led to complete healing of the mucosal lesion and return of both biochemical function and small bowel roentgenologic pattern to normal in only 35% of previously untreated patients and only 25% of those with chronic sprue. In both groups, healing required prolonged therapy and was seldom evident before 1 year of therapy. This study reflects the chronic nature of the disease and the persistence of the mucosal lesion in the face of apparent clinical recovery. It also showed that the mucosal lesion can heal in tropical sprue.