Tropical Diseases and the Gastrointestinal Tract: An Overlooked Connection

Ramy Mohamed Ghazy^1,2*Saleh Ahmed Alshaikhi³Hassan Ahmed Hassan Assiri³Adel Ahmed Almozaini⁴Abdullah Faisal Alhazmi^3,5Heba Elsaeed Mohammed Elhasaneen³Sarah M. Abdo^6*

• ¹Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
• ²College of Medicine, King Khalid University, Abha, Asir, Saudi Arabia
• ³Ministry of Health (Saudi Arabia), Riyadh, Riyadh, Saudi Arabia
• ⁴King Abdulaziz Medical City, Riyadh, Saudi Arabia
• ⁵King Abdullah Medical City, Makkah, Saudi Arabia
• ⁶Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt

Background: Tropical infectious diseases continue to impose a significant public health burden, particularly in regions with poor sanitation, limited healthcare access, and favorable environmental conditions for pathogen transmission. Gastrointestinal (GI) involvement is a key clinical feature across many of these diseases, contributing significantly to global morbidity and mortality. Despite increasing awareness, few existing reviews comprehensively integrate the pathophysiology of GI involvement, diagnostic challenges, and multidisciplinary public health strategies, including the One Health approach. Methods: This narrative review synthesizes current evidence on tropical diseases with GI manifestations. A structured literature search was conducted using major databases. Key themes were identified through thematic synthesis, including disease mechanisms, diagnostic limitations, treatment options, and prevention strategies. Results: A significant number of tropical diseases spread through the faecal-oral route, primarily due to contaminated food or water, particularly in areas with poor sanitation. These include helminthic, protozoal, bacterial, and viral infections. Vector-borne diseases and zoonotic infections also present substantial GI involvement. Chronic parasitic presence triggers inflammation, fibrosis, and oxidative stress, leading to tissue damage and long-term complications, including cancers. Misdiagnosis of GI symptoms as more common conditions like irritable bowel syndrome delays appropriate care and worsens outcomes. The globalization of travel and commerce has widened the spread of these diseases, with travellers, immigrants, and refugees frequently exhibiting unfamiliar GI symptoms in non-endemic regions. Conclusion: A multifaceted strategy is essential for effective management, including improved sanitation, enhanced diagnostic tools, mass drug administration, and vector control. The One Health framework provides a sustainable model by integrating human, animal, and environmental health perspectives. Aligning interventions with global targets such as the Sustainable Development Goals (SDGs) and the WHO's 2030 roadmap for neglected tropical diseases (NTDs) can reduce health disparities, improve nutrition, and strengthen resilience against emerging threats.