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Differential Diagnosis of Chronic Diarrhea

New Insights into Whipple’s Disease – A Rare Intestinal Inflammatory Disorder

Marth T.

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Division of Internal Medicine, Krankenhaus Maria Hilf, Daun, Germany

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Dig Dis 2009;27:494–501

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Article / Publication Details

First-Page Preview
Abstract of Differential Diagnosis of Chronic Diarrhea

Published online: November 04, 2009
Issue release date: November 2009

Number of Print Pages: 8
Number of Figures: 3
Number of Tables: 3

ISSN: 0257-2753 (Print)
eISSN: 1421-9875 (Online)

For additional information: https://www.karger.com/DDI

Abstract

Whipple’s disease (WD) is a rare systemic infectious disor- der caused by the actinomycete Tropheryma whipplei. This chronic disease, first described by Whipple as ‘intestinal lipodystrophy’, affects preferentially middle-aged white men who may present with weight loss, diarrhea, abdominal pain and arthralgia. Thus, it represents an important differential diagnosis of chronic diarrhea. A variety of other clinical patterns, such as involvement of the heart, lung, or central nervous system (CNS), are frequent. In addition, individuals with isolated heart valve involvement or asymptomatic carriers may be observed. The diagnosis often is established by small bowel biopsy, which is characterized by periodic acid-Schiff-positive inclusions representing the causative bacteria. T. whipplei can be detected by specific polymerase chain reaction, immunohistochemistry or electron microscopy and was cultured a few years ago. Several studies show that subtle defects of the cell-mediated immunity exist in active and inactive WD which may predispose individuals with a certain HLA type to a clinical manifestation of T. whipplei infection. As confirmed in a recent controlled trial, most patients respond well to a prolonged antibiotic treatment, but some patients with relapsing disease or CNS manifestation may have a poor prognosis. In the presentation, the relevance of WD in the differential diagnosis of chronic diarrhea and the new findings of this enigmatic rare disorder will be discussed.

© 2009 S. Karger AG, Basel


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Article / Publication Details

First-Page Preview
Abstract of Differential Diagnosis of Chronic Diarrhea

Published online: November 04, 2009
Issue release date: November 2009

Number of Print Pages: 8
Number of Figures: 3
Number of Tables: 3

ISSN: 0257-2753 (Print)
eISSN: 1421-9875 (Online)

For additional information: https://www.karger.com/DDI


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