Environmental enteropathy

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Villous atrophy in endoscopic images

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Environmental enteropathy - mechanism model

AFRICA BASIN AND PITCHER FOR WASHING HANDS

Environmental enteropathy (EE), also known as tropical enteropathy or environmental enteric dysfunction (EED), is a disorder of the small intestine characterized by chronic inflammation, villous atrophy, and increased intestinal permeability. This condition is prevalent in low- and middle-income countries and is associated with poor sanitation and hygiene.

Pathophysiology

Environmental enteropathy is believed to result from chronic exposure to fecal pathogens due to inadequate sanitation and hygiene practices. The continuous ingestion of these pathogens leads to a persistent inflammatory response in the gut. This inflammation causes damage to the intestinal villi, leading to villous atrophy, which impairs nutrient absorption and increases intestinal permeability. The increased permeability allows for the translocation of bacteria and toxins into the bloodstream, contributing to systemic inflammation and malnutrition.

Clinical Manifestations

The clinical manifestations of environmental enteropathy are often subtle and nonspecific. They may include:

• Growth stunting
• Malnutrition
• Impaired cognitive development
• Diarrhea
• Anemia

Diagnosis

Diagnosis of environmental enteropathy is challenging due to the lack of specific clinical symptoms and the need for invasive procedures to obtain intestinal biopsies. However, several biomarkers and non-invasive tests are being researched to aid in the diagnosis. These include:

• Lactulose-mannitol test
• Fecal calprotectin
• Serum citrulline levels

Management

There is no specific treatment for environmental enteropathy. Management focuses on improving sanitation and hygiene to reduce exposure to fecal pathogens. Nutritional interventions, such as supplementation with vitamins and minerals, are also important to address malnutrition and support growth and development.

Prevention

Preventive measures for environmental enteropathy include:

• Improving water quality
• Promoting handwashing with soap
• Enhancing sanitation facilities
• Educating communities about hygiene practices

Related Pages

• Malnutrition
• Diarrhea
• Anemia
• Intestinal permeability
• Villous atrophy
• Sanitation

See Also

• Tropical sprue
• Celiac disease
• Small intestine bacterial overgrowth