title: Distinguishing tropical sprue from celiac disease in returning travellers with chronic diarrhoea: a diagnostic challenge?
abstract: BACKGROUND
  Within the present era of worldwide travel, it is important for all clinicians to consider the possibility of tropical sprue (TS) in returning patients with persistent diarrhoea after travel. The symptoms and histologic findings of TS can resemble but also be confused with celiac disease (CD).
  
  
  METHODS
  Patients at our institute diagnosed with CD or TS in the period January 2000-December 2010 were eligible for inclusion. Of all patients, demographic, clinical, laboratory and endoscopy data on admission and in follow-up were collected retrospectively.
  
  
  RESULTS
  28 CD and 7 TS patients were included. There were no differences in baseline clinical characteristics, duration of stay in a tropical region or in laboratory findings on admission. However, in the majority of CD patients antibodies against endomysium (EMA) or tissue transglutaminase (tTG) were present at presentation but absent in all TS patients at presentation.
  
  
  CONCLUSIONS
  In returning travellers with persistent diarrhoea, a diagnosis of CD is unlikely in case of absence of anti-EMA or anti-tTG antibodies but conversely increases the likelihood of TS. This distinct immunoserological profile may be of help in selecting the optimal treatment in returning travelers with chronic diarrhoea after staying in a tropical region.
authors.affiliation: Institute for Tropical Diseases, Department of Internal Medicine, Harbour Hospital Rotterdam, Haringvliet 2, 3011 TD Rotterdam, The Netherlands. Electronic address: mcclangenberg@gmail.com.
authors.forename: Marijke C C
authors.initials: MC
authors.lastname: Langenberg
authors.affiliation: Travel Clinic Havenziekenhuis, Haringvliet 72, 3011 TD Rotterdam, The Netherlands. Electronic address: p.wismans@havenziekenhuis.nl.
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Wismans
authors.affiliation: Institute for Tropical Diseases, Department of Internal Medicine, Harbour Hospital Rotterdam, Haringvliet 2, 3011 TD Rotterdam, The Netherlands; Travel Clinic Havenziekenhuis, Haringvliet 72, 3011 TD Rotterdam, The Netherlands. Electronic address: p.van.genderen@havenziekenhuis.nl.
authors.forename: Perry J J
authors.initials: PJ
authors.lastname: van Genderen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D002908:Chronic Disease; D003967:Diarrhea / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013182:Sprue, Tropical / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D014195:Travel; D055815:Young Adult
keywords: Celiac disease; Diarrhoea; Sprue; Traveller