Folate in Tropical Sprue

Summary. Persons who acquire tropical sprue lose their ability to absorb folate from the diet. This is due to inability to hydrolyse polyglutamate forms in most cases and additionally to absorb monoglutamate folate in instances of severe mucosal damage. Neither the specific site of impaired deconjugation nor the acutal defect in the transport process are known. Malabsorption of folate results in a sequence of events similar to that which occurs when folate is deleted from the diet: prompt fall in serum concentration followed by development of megaloblastic changes in the bone marrow and eventually anaemia. Reduced tissue stores, if present due to inadequate intake or increased requirement, increases the rapidity of folate depletion. Prompt but partial response of the mucosal abnormality to treatment with folic acid indicates that once acquired, folate deficiency acts in some unexplained manner to perpetuate the intestinal lesion.