Clinical and Histological Co-occurrence of Tropical Sprue and Helicobacter pylori Infection in Northeastern India: An Observational Study

TL;DR

This study finds a strong link between tropical sprue and Helicobacter pylori infection in northeastern India, suggesting they often co-occur and should be evaluated together.

Contribution

The study provides new evidence for the clinical coexistence of tropical sprue and Helicobacter pylori infection in a tropical region.

Findings

53 out of 67 patients had both Helicobacter pylori infection and tropical sprue features.

Tropical sprue was often misdiagnosed due to symptom overlap with H. pylori infection.

The study highlights the need for combined evaluation of both conditions in patients with malabsorption symptoms.

Abstract

Background: Tropical sprue (TS) and infection caused by Helicobacter pylori are a frequent cause of morbidity in the tropics. These disease entities, apart from having common regional distribution, probably also share hosts, sometimes exhibit symptom overlap, and very likely modify each other’s course. The data supporting this association is scant and may testify to the association between them in causing human suffering.

Methods: We enrolled 67 patients with dyspepsia, who also had an associated history suggestive of malabsorption (any two of the following: chronic diarrhea greater than four weeks and/or unintentional significant weight loss of >5% body weight over three months and/or nutritional deficiency of iron, B12, or folate in various proportions). They presented to the gastroenterology referral OPD of a tertiary care hospital in the northeastern region of India over a period of two and a half years. These patients were incorporated after informed consent and after fulfilling the inclusion and exclusion criteria. They initially underwent a battery of blood and stool tests to exclude other prevalent causes of malabsorption. This was followed by upper gastrointestinal endoscopy with additional rapid urease testing (RUT) wherever indicated, and mandatory biopsies were taken from the stomach corpus, antrum, and the second part of the duodenum.

Results: A significant 53 of 67 patients were found to have H. pylori infection (as diagnosed by endoscopic findings, RUT, and histopathological examination of gastric biopsies) and concurrent features of TS on duodenal biopsies.

Conclusion: Literature supporting such a close association between TS and H. pylori is scarce, and presentation of TS as dyspepsia is peculiar and unusual. This study offers new insights into the symptom overlap and coexistence of H. pylori infection and TS. In patients presenting with H. pylori infection and features of malabsorption, it is clinically prudent to evaluate for underlying TS to ensure a more inclusive and effective treatment approach.

Figures