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Esprúe tropical

Definición

Es una enfermedad que se presenta en personas que visitan áreas tropicales o que viven allí por largos períodos de tiempo. Este trastorno altera la absorción de nutrientes de los intestinos.

El esprúe tropical es un síndrome caracterizado por una diarrea aguda o crónica, pérdida de peso, y malabsorción de nutrientes.

Causas

La enfermedad es causada por el daño al revestimiento del intestino delgado. Se da por tener demasiada cantidad de ciertos tipos de bacterias en los intestinos.

Los factores de riesgo son:

• Vivir en los trópicos
• Largos períodos de viajes a destinos tropicales

Síntomas

Los síntomas incluyen:

• Cólicos abdominales
• Diarrea que empeora con dietas ricas en grasa
• Gases excesivos (flatos)
• Fatiga
  
• Fiebre
  
• Hinchazón en la pierna
  
• Pérdida de peso

Los síntomas pueden no aparecer hasta por 10 años después de haber dejado los trópicos.

Pruebas y exámenes

No hay un marcador claro o examen que diagnostique claramente este problema.

Ciertos exámenes ayudan a confirmar que la malabsorción de nutrientes esta presente:

• Prueba de D-xilosa para ver qué tan bien absorben el azúcar simple los intestinos
• Exámenes de heces para ver si la grasa se absorbe correctamente
• Exámenes de sangre para medir el hierro, folato, vitamina B12 o vitamina D
• Conteo sanguíneo completo (CSC)

Los exámenes para analizar el intestino delgado pueden incluir:

• Enteroscopia
• Endoscopia de vías digestivas altas
• Biopsia del intestino delgado
• Tránsito esofagogastroduodenal

Tratamiento

El tratamiento comienza con mucho líquido y electrólitos. Igualmente, se puede requerir la reposición de folato, hierro, vitamina B12 y otros nutrientes. La terapia antibiótica con tetraciclina o trimetoprim con sulfametoxazol generalmente se administra durante 3 a 6 meses.

En la mayoría de los casos, la tetraciclina oral no se prescribe para los niños hasta que les hayan salido todos los dientes definitivos. Este medicamento puede decolorar de manera permanente los dientes que aún se están formando. Sin embargo, se pueden usar otros antibióticos

Expectativas (pronóstico)

El pronóstico es bueno con tratamiento.

Posibles complicaciones

Las deficiencias de vitaminas y minerales son comunes.

En los niños, el esprúe lleva a:

• Retraso en la maduración de los huesos (maduración esquelética)
• Retraso del crecimiento

Cuándo contactar a un profesional médico

Comuníquese con su proveedor de atención médica si:

• Los síntomas del esprúe tropical empeoran o no mejoran con el tratamiento.
• Presenta nuevos síntomas.
• Tiene diarrea u otros síntomas de este trastorno por un período prolongado, especialmente después de haber pasado un tiempo en el trópico.

Prevención

Aparte de evitar vivir en o viajar a climas tropicales, no existe prevención conocida para el esprúe tropical.

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