Intestinal bleeding in patients with Whipple's disease

Feldman, Mark; Price, Gary

doi:10.1016/0016-5085(89)91643-0

Cited by 14 publications

(9 citation statements)

References 6 publications

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“…Chronic anaemia was a recurrent problem in our patient. Although anaemia is a common finding in patients with Whipple's disease, reported in up to 75 % of cases [4], this feature is not consistently mentioned in textbooks or review articles [1,17]. A plausible explanation for the anaemia in Whipple's disease is iron malabsorption in the proximal small intestine [17].…”

Section: Discussionmentioning

confidence: 99%

“…Although anaemia is a common finding in patients with Whipple's disease, reported in up to 75 % of cases [4], this feature is not consistently mentioned in textbooks or review articles [1,17]. A plausible explanation for the anaemia in Whipple's disease is iron malabsorption in the proximal small intestine [17]. Bleeding has occasionally been described in case reports of patients with Whipple's disease [12], including in some who had been receiving steroids or nonsteroidal anti-inflammatory drugs [17].…”

Section: Discussionmentioning

confidence: 99%

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Refractory Whipple’s Disease with Anaemia: First Lessons from Capsule Endoscopy

Fritscher-Ravens¹,

Swain²,

Herbay³

2004

Endoscopy

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Whipple's disease is a chronic multisystem disorder caused by infection with the rod-shaped bacterium, Tropheryma whippelii. We report the case of a 65-year-old woman with intestinal Whipple's disease that had been refractory to monotherapy with a number of antibiotics over a 2-year period. The patient then presented with watery diarrhoea, cachexia (body mass index 18 kg/m (2)) and chronic anaemia (haemoglobin 7.6 g/dl). Wireless capsule endoscopy showed that the disease affected the entire small intestine. Focal occult areas of bleeding were observed in different parts of the jejunum. The capsule's transit time through the small intestine was 2 hours 43 minutes. Capsule endoscopy allows novel insights into the pathophysiology of Whipple's disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Refractory Whipple’s Disease with Anaemia: First Lessons from Capsule Endoscopy

Fritscher-Ravens¹,

Swain²,

Herbay³

2004

Endoscopy

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“…Other intestinal symptoms such as abdominal bloating and cramps may be present but are rare. Occasional bleeding, manifested by hematochezia and probably due to intestinal lesions comparable to those seen in untreated celiac disease (gluten-sensitive enteropathy), has been found in patients with Whipple's disease (13,60,114).…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Whipple's Disease and “Tropheryma whippelii”

2001

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SUMMARY Whipple's disease is a rare bacterial infection that may involve any organ system in the body. It occurs primarily in Caucasian males older than 40 years. The gastrointestinal tract is the most frequently involved organ, with manifestations such as abdominal pain, malabsorption syndrome with diarrhea, and weight loss. Other signs include low-grade fever, lymphadenopathy, skin hyperpigmentation, endocarditis, pleuritis, seronegative arthritis, uveitis, spondylodiscitis, and neurological manifestations, and these signs may occur in the absence of gastrointestinal manifestations. Due to the wide variability of manifestations, clinical diagnosis is very difficult and is often made only years or even decades after the initial symptoms have appeared. Trimethoprim-sulfamethoxazole for at least 1 year is usually considered adequate to eradicate the infection. The microbiological diagnosis of this insidious disease is rendered difficult by the virtual lack of culture and serodiagnostic methods. It is usually based on the demonstration of periodic acid-Schiff-positive particles in infected tissues and/or the presence of bacteria with an unusual trilaminar cell wall ultrastructure by electron microscopy. Recently, the Whipple bacteria have been characterized at the molecular level by amplification of their 16S rRNA gene(s). Phylogenetic analysis of these sequences revealed a new bacterial species related to the actinomycete branch which was named “Tropheryma whippelli.” Based on its unique 16S ribosomal DNA (rDNA) sequence, species-specific primers were selected for the detection of the organism in clinical specimens by PCR. This technique is currently used as one of the standard methods for establishing the diagnosis of Whipple's disease. Specific and broad-spectrum PCR amplifications mainly but not exclusively from extraintestinal specimens have significantly improved diagnosis, being more sensitive than histopathologic analysis. However, “T. whippelii” DNA has also been found in persons without clinical and histological evidence of Whipple's disease. It is unclear whether these patients are true asymptomatic carriers or whether differences in virulence exist among strains of “T. whippelii” that might account for the variable clinical manifestations. So far, six different “T. whippelii” subtypes have been found by analysis of their 16S-23S rDNA spacer region. Further studies of the pathogen “T. whippelii” as well as the host immune response are needed to fully understand this fascinating disease. The recent cultivation of the organisms is a promising major step in this direction.

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“…Indeed, while our patient was twice hospitalized (in 1983 and in 1997), the laboratory, histological and endoscopic examinations were seeking lesions consistent with a diagnosis of either Crohn's disease or another systemic disorder (such as Behcet disease or familial Mediterranean fever). 9 The combination of digestive symptoms that include diarrhoea, anorexia and malabsorption, are the most prominent in Whipple's disease; however, other nonspecific abdominal symptoms, like cramping and bloating, also are found.…”

Section: Discussionmentioning

confidence: 99%