Changes in the world political situation, the rapidity of transportation, and the availability of effective
therapy have altered the pattern of
sprue in persons going to the tropics. Gone, for the most part, are the days when expatriates liver for years in tropical areas, progressed on the full-blown pattern of debilitating disease when they acquired
sprue, and then were never totally cured either by return home or by the then-available forms of
therapy. Today, visitors to the tropics usually return home by jet aircraft within weeks or months after acquiring the disease, and thus they present just with manifestations of small bowel disease in the absence of
nutritional deficiencies. In this circumstance, the differential diagnosis usually lies between
sprue and
giardiasis. Both of these disorders are caused by chronic contamination of the small bowel by enteric pathogens, and both can be cured by specific
therapy directed at eradicating these organisms. In contrast to the situation in travelers,
sprue among the indigenous population of the tropics remains largely unchanged: a chronic debilitating disorder that represents a significant contributory factor to the pathogenesis of morbidity and
malnutrition in some areas.