Environmental enteropathy

Environmental enteropathy
Other namesTropical enteropathy or Environmental enteric dysfunction
Tropical enteropathy, environmental enteric dysfunction
Histological evidence of enteropathy (inflammatory infiltrate, villus blunting) seen in this intestinal biopsy from a child with malnutrition.[1]
SpecialtyGastroenterology
SymptomsAsymptomatic (most common), altered stool consistency, increased stool frequency, weight loss
ComplicationsMalnutrition, malabsorption, growth stunting, developmental delay, impaired response to oral vaccines
DurationChronic
CausesUnsanitary food and water sources, fecal-oral contamination, chronic enteric infections, mucosal inflammation
Diagnostic methodIntestinal biopsy (gold standard), abnormal sugar absorption test, clinical (significantly more common)
Differential diagnosisTropical sprue
PreventionSanitation

Environmental enteropathy (EE or tropical enteropathy or environmental enteric dysfunction or EED) is an acquired small intestinal disorder characterized by gut inflammation, reduced absorptive surface area in small intestine, and disruption of intestinal barrier function.[2][3][1][4][5] EE is most common amongst children living in low-resource settings.[2][3][1] Acute symptoms are typically minimal or absent.[3] EE can lead to malnutrition, anemia (iron-deficiency anemia and anemia of chronic inflammation),[2] stunted growth, impaired brain development,[6][7][8] and impaired response to oral vaccinations.[9][10]

The cause of EE is multifactorial. Overall, exposure to contaminated food and water leads to a generalized state of intestinal inflammation.[2][3][1] The inflammatory response results in multiple pathological changes to the gastrointestinal tract: Smaller villi, larger crypts (called crypt hyperplasia), increased permeability, and inflammatory cell build-up within the intestines.[3][1][11] These changes result in poor absorption of food, vitamins and minerals.

Standardized, clinically practical diagnostic criteria do not exist. The most accurate diagnostic test is intestinal biopsy. However, this test is invasive and unnecessary for most patients.[2]

Prevention is the strongest and most reliable option for preventing EE and its effects. Therefore, prevention and treatment of EE are often discussed together.[11][12][13]

  1. ^ a b c d e Louis-Auguste J, Kelly P (July 2017). "Tropical Enteropathies". Current Gastroenterology Reports. 19 (7): 29. doi:10.1007/s11894-017-0570-0. PMC 5443857. PMID 28540669.
  2. ^ a b c d e Ali A, Iqbal NT, Sadiq K (January 2016). "Environmental enteropathy". Current Opinion in Gastroenterology. 32 (1): 12–17. doi:10.1097/MOG.0000000000000226. PMID 26574871. S2CID 40064894.
  3. ^ a b c d e Korpe PS, Petri WA (June 2012). "Environmental enteropathy: critical implications of a poorly understood condition". Trends in Molecular Medicine. 18 (6): 328–336. doi:10.1016/j.molmed.2012.04.007. PMC 3372657. PMID 22633998.
  4. ^ Marie C, Ali A, Chandwe K, Petri WA, Kelly P (September 2018). "Pathophysiology of environmental enteric dysfunction and its impact on oral vaccine efficacy". Mucosal Immunology. 11 (5): 1290–1298. doi:10.1038/s41385-018-0036-1. PMID 29988114. S2CID 256559217.
  5. ^ Denno DM, Tarr PI, Nataro JP (December 2017). "Environmental Enteric Dysfunction: A Case Definition for Intervention Trials". The American Journal of Tropical Medicine and Hygiene. 97 (6): 1643–1646. doi:10.4269/ajtmh.17-0183. PMC 5805039. PMID 29016294.
  6. ^ Ngure FM, Reid BM, Humphrey JH, Mbuya MN, Pelto G, Stoltzfus RJ (January 2014). "Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: making the links". Annals of the New York Academy of Sciences. 1308 (1): 118–128. Bibcode:2014NYASA1308..118N. doi:10.1111/nyas.12330. PMID 24571214. S2CID 21280033.
  7. ^ Bhutta ZA, Guerrant RL, Nelson CA (April 2017). "Neurodevelopment, Nutrition, and Inflammation: The Evolving Global Child Health Landscape". Pediatrics. 139 (Suppl 1): S12–S22. doi:10.1542/peds.2016-2828d. PMID 28562245.
  8. ^ John CC, Black MM, Nelson CA (April 2017). "Neurodevelopment: The Impact of Nutrition and Inflammation During Early to Middle Childhood in Low-Resource Settings". Pediatrics. 139 (Suppl 1): S59–S71. doi:10.1542/peds.2016-2828h. PMC 5694688. PMID 28562249.
  9. ^ Oriá RB, Murray-Kolb LE, Scharf RJ, Pendergast LL, Lang DR, Kolling GL, Guerrant RL (June 2016). "Early-life enteric infections: relation between chronic systemic inflammation and poor cognition in children". Nutrition Reviews. 74 (6): 374–386. doi:10.1093/nutrit/nuw008. PMC 4892302. PMID 27142301.
  10. ^ Czerkinsky C, Holmgren J (June 2015). "Vaccines against enteric infections for the developing world". Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences. 370 (1671): 20150142. doi:10.1098/rstb.2015.0142. PMC 4527397. PMID 25964464.
  11. ^ a b Prendergast A, Kelly P (May 2012). "Enteropathies in the developing world: neglected effects on global health". The American Journal of Tropical Medicine and Hygiene. 86 (5): 756–763. doi:10.4269/ajtmh.2012.11-0743. PMC 3335677. PMID 22556071.
  12. ^ Humphrey JH (September 2009). "Child undernutrition, tropical enteropathy, toilets, and handwashing". Lancet. 374 (9694): 1032–1035. doi:10.1016/s0140-6736(09)60950-8. PMID 19766883. S2CID 13851530.
  13. ^ Mbuya MN, Humphrey JH (May 2016). "Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: an opportunity for stunting reduction in developing countries". Maternal & Child Nutrition. 12 (Suppl 1): 106–120. doi:10.1111/mcn.12220. PMC 5019251. PMID 26542185.