Table 1.

Differential for non-infectious Tropical malabsorption

	Environmental Enteropathy	Tropical Sprue	Celiac Sprue	Crohn’s Disease
Characteristic signs and symptoms	Subclinical; can have mild malabsorption and be associated with growth faltering	Chronic diarrhea, weight loss, manifestations of nutritional deficiencies	A minority of patients have the classic diarrhea- predominant form; more patients have “silent” disease, characterized by lack of symptoms or extraintestinal symptoms, such as arthritis, infertility, anemia, and osteoporosis	Perianal abscesses, intestinal fistulas, and strictures; individuals are at increased risk for PSC, ankylosing spondylsis, and psoriasis
Histopathology	Blunting of intestinal villi, increased crypt lengthening, intraepithelial lymphocytes and lymphocytic infiltration of the lamina propria	Blunting of intestinal villi, increased crypt lengthening, increased mononuclear inflammatory cells and intraepithelial lymphocytes.	*indistinguishable from EE	Active and chronic inflammation, variable distortion to villous architecture, metaplastic epithelial changes, possible granulomas
Serologic diagnosis	No established biochemical parameters for diagnosis	No established biochemical parameters for diagnosis	Anti-tissue transglutaminse antibody; anti- endomysial antibody; anti- gliadin Ab (nonspecific)	No established biochemical parameters for diagnosis
Etiology	Recurrent environmental exposure to fecal contamination	Infectious	Genetic predisposition with presence of HLA-DQ2 or HLA- DQ8 initiated by exposure to gluten proteins. Pathogenesis due to both t-cell and antibody- mediated response.	Unknown; genetic predisposition to certain forms of the disease, involving NOD2 and autophagy gene (ATG161L).
Available treatment	None	May respond to tetracycline therapy	Avoidance of gluten in diet	Corticosteroids and immunomodulating drugs
Refs	2	2,63	32, 80	64