Environmental Enteropathy: Causes, Symptoms, Treatment, Prevention, Diagnosis

Environmental enteropathy is a disorder characterized by chronic inflammation of the intestines. Other names of Environmental Enteropathy are Environmental Enteric Dysfunction and Tropical Enteropathy. Environmental enteropathy is commonest in children who are living in low-resource situations with poor sanitary conditions. The cause of Environmental Enteropathy is multi-factorial. The common cause of Environmental Enteropathy includes exposure to contaminated water and food. Patients suffering Environmental Enteropathy usually do not experience acute symptoms. Environmental enteropathy can cause anemia, malnutrition, impaired brain development, growth stunting and impaired response to oral vaccinations in the patient. As of now, intestinal biopsy is the accurate diagnostic procedure for Environmental Enteropathy. Prevention is the best treatment of Environmental Enteropathy or Tropical Enteropathy and its resulting symptoms.

Environmental Enteropathy is multifactorial in development. Environmental Enteropathy mainly occurs as a result of chronic exposure to contaminated water and food; especially seen in areas where there is lack of sanitation and widespread open defecation. Such type of long-term exposure to the pathogens causes generalized state of intestinal inflammation leading to functional as well as structural changes in the gut permeability and intestinal absorption.

There are various pathological changes occurring in the gastrointestinal tract as a result of the inflammation in Environmental Enteropathy, such as crypt hyperplasia, smaller villi, inflammatory cell build-up and increased permeability in the gut. All these pathological changes are responsible for causing poor absorption of food, minerals and vitamins in the intestine.

The primary symptoms of Environmental Enteropathy include chronic malnutrition and growth stunting along with other development deficits in children/patients.

Environmental Enteropathy rarely produces acute symptoms and is considered a subclinical disorder. However, if Environmental Enteropathy occurs in adults, then mild symptoms of malabsorption develop, such as changes in stool consistency, weight loss and increased stool frequency.

Malnutrition: As mentioned before, malnutrition is the primary long-term symptom of Environmental Enteropathy along with nutritional deficiencies.

Stunted Growth & Neurocognitive Deficits: There is delayed development in the growth of the children suffering from Environmental Enteropathy. Patient also has delayed brain development, which consists of neurocognitive deficits caused by Environmental Enteropathy.

Decreased Efficacy of Oral Vaccination: Patients suffering from Environmental Enteropathy will not get the complete benefit of oral vaccination, as the efficacy of oral vaccination gets reduced due to this disorder.

Currently, intestinal biopsy with histological analysis is the accurate diagnostic procedure for Environmental Enteropathy. However, it is considered invasive and expensive. Research is going on for other diagnostic methods which are less invasive to diagnose Environmental Enteropathy.

Earlier there was a syndrome reported predominantly in tropical areas across sub-Saharan Africa, Latin America and Asia; which consisted of non-specific functional and histopathological changes to the small intestine in people who were living in unsanitary conditions. Due to the geographic distribution, this syndrome was coined as “Tropical Enteropathy.”

However, after further research, it was found that this syndrome was not specific to tropical regions/climates and it was also found in developing countries; nonetheless associated with impoverished conditions. As a result, a new term was coined to describe this syndrome, which was “Environmental Enteropathy” indicating that this condition is caused by environmental factors and is not specific to tropical areas.

Treatment for Environmental Enteropathy or Tropical Enteropathy aims in addressing the inflammation of the intestine, treating the growth of the bacteria and giving nutritional supplementation to the patient.

For preventing Environmental Enteropathy, it is important to follow sanitary measures like keeping the household clean, instructing the children to wash hands before and after meals. Mothers should wash their hands before preparing food. Safe disposal of excreta is also important in preventing Environmental Enteropathy or Tropical Enteropathy. Measures should be taken to improve the sanitation of food and water sources. One of the important preventive measures of Environmental Enteropathy is that children should play in clean play areas and should avoid playing in contaminated soil caused by the presence of livestock such as chicken.

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