Tropical sprue enteritis and diarrhea

　　The etiology has not been fully elucidated, and it is currently believed that it may be caused by a single or multiple pathogenic microorganisms or parasites, a chronic small intestinal infection with no clear relationship to gluten-containing diet. The disease has epidemic and seasonal characteristics, and treatment with broad-spectrum antibiotics is effective, but no pathogenic bacteria have been found in feces, small intestinal contents, and intestinal mucosa. Nutritional deficiencies, such as protein, vitamin B group, folic acid, etc., may be related to the onset of the disease.

　　Tropical sprue enteritis and diarrhea often occur with anemia, hypoalbuminemia, abnormal glucose tolerance, and other complications. Accompanied by weight loss, fatigue, anemia, edema, etc. High fever, vomiting, followed by frequent bowel movements, leading to incontinence, purulent blood stools, severe abdominal pain, significant urgent need to defecate, more severe cases with fluid depletion, cold extremities, dizziness, frequent vomiting, frequent convulsions, red and dark tongue coating, yellow and dry tongue fur, slippery and rapid or extremely fine pulse.

　　The patient has fatigue, abdominal pain, diarrhea, feces 1-2 times a day or up to ten times, large stool volume, paste-like consistency, light color, foul smell, greasy foamy. About 30% of cases have steatorrhea, hypoalbuminemia, and oral protein tolerance test shows delayed absorption. 50% of patients have abnormal glucose tolerance, and about 90% of cases have reduced urine output in xylose absorption test. Vitamin A and B12 absorption tests are also abnormal.

　　Patients should have a reasonable diet, with a variety of food types and rich in nutrition. Appropriate fluid replacement should be done to correct electrolyte imbalance. Foods that are difficult to digest and increase the burden on the gastrointestinal tract should be avoided, as they can stimulate gastrointestinal motility and exacerbate diarrhea. Therefore, vegetable oils should also be limited, and cooking methods should be paid attention to, mainly steaming, boiling, blanching, braising, and roasting, and oil-frying, stir-frying, and slippery cooking should be prohibited. Foods that can be eaten include lean meat, chicken, shrimp, fish, and soy products. Pay attention to low fiber, as foods rich in rough fiber can stimulate intestinal motility and exacerbate diarrhea. When diarrhea occurs frequently, it is best to temporarily not eat or eat as little as possible vegetables and fruits, and fresh fruit juice and tomato juice can be given to supplement vitamins; low fiber diet can reduce intestinal motility and alleviate diarrhea, so it is advisable to eat thin noodles, congee, and porridge.

　　Tropical sprue diarrhea should be examined with small intestinal biopsy, vitamin A and B12 absorption test, xylose absorption test, glucose tolerance test, and oral protein tolerance test.

　　The diet of tropical sprue diarrhea patients should be easy to digest, low in fiber, and avoid cold and raw foods. Red dates, Chinese yam, chestnuts, lentils, glutinous rice, and lotus seeds have the effect of invigorating the spleen, strengthening the intestines, and stopping diarrhea, so it is not advisable to eat too much. Apples can stop diarrhea, and they can also be eaten more after being cooked. Tropical sprue diarrhea patients should avoid eating raw garlic, as the pungency of garlic can stimulate the intestinal wall and exacerbate diarrhea. Avoid cold and raw foods.

　　Firstly, provide a diet rich in nutrition, appropriate fluid replacement, and correct electrolyte imbalance. For those with frequent diarrhea, antidiarrheal agents should be given. Vitamin B12 and folic acid treatment should be continued for one year. At the same time, antibiotic treatment should be given, taking tetracycline 250-500mg orally, 4 times a day, for a total of 1 month, then changed to 2 times a day, for a total of 5-6 months. Sulfonamide drugs are also effective, taking sulfasuxidine (sulfasuxidine) 1.0g, 4 times a day, orally for 1 month, then changed to 2 times a day, for a total of 5 months. After treatment, anemia and glossitis recover rapidly, appetite improves, weight increases, and changes in intestinal mucosa improve, and the activity of intestinal mucosal enzymes increases. Some cases respond slowly to treatment, and symptoms and malabsorption persist for a long time, so the treatment time needs to be long.