Whipple's disease (patient information)
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-in-Chief: Meagan E. Doherty; Sadaf Sharfaei M.D.[2]
Overview
Whipple's disease is a rare condition that prevents the intestine from properly absorbing nutrients. This is called malabsorption.
What are the symptoms of Whipple's disease?
Symptoms usually start slowly. Joint pain is the most common initial symptom. After that, often several years later, symptoms of gastrointestinal infection develop. Other symptoms may include:
- Abdominal pain
- Diarrhea
- Fever
- Gray to brown skin color
- Joint pain in the ankles, knees, elbows, fingers, or other areas
- Memory loss
- Personality changes
- Weight loss
What causes Whipple's disease?
Whipple's disease is caused by bacteria named Tropheryma whipplei. It can affect any system of the body, but occurs most often in the small intestine. Lesions appear on the wall of the small intestine and thicken the tissue. The villi—tiny, finger-like protrusions from the wall that help absorb nutrients—are damaged.
Who is at highest risk?
Although risk factors for Whipple's disease are unknown, the disorder mainly affects middle-aged white men.
Diagnosis
Possible signs:
- Enlarged lymph nodes
- Fatty stools
- Gastrointestinal bleeding
- Swelling in body tissues (edema)
Tests may include:
- Complete blood count
- Polymerase chain reaction (PCR) test to check for the bacteria that causes the disease
- Small bowel biopsy
- Upper GI endoscopy (viewing the intestines with a flexible, lighted tube in a process called enteroscopy)
This disease may also change the results of the following tests:
- Albumin
- Unabsorbed fat in the stools (fecal fat)
- Intestinal absorption of a type of sugar (d-xylose absorption)
When to seek urgent medical care?
Call your healthcare provider if you have persistent abdominal pain and diarrhea.
If you are being treated for Whipple's disease, call your healthcare provider if:
Treatment options
You will need to take long-term antibiotics to cure any infections of the brain and central nervous system. A medicine called ceftriaxone is given through a vein. It is followed by an antibiotic (such as trimethoprim-sulfamethoxazole) taken by mouth for up to 1 year.
If symptoms come back during antibiotic use, the antibiotic treatment may be changed.
Your healthcare provider should closely follow you, because signs of the disease can return after you finish therapy. Those who have nutritional deficiencies from malabsorption will also need to take dietary supplements.
Depending on the seriousness of the disease, treatment may also include fluid and electrolyte replacement. Electrolytes are salts and other substances in body fluid that the heart and brain need to function properly. Extra iron, folate, vitamin D, calcium, and magnesium may also be given to help compensate for the vitamins and minerals the body cannot absorb on its own.
Where to find medical care for Whipple's disease?
Directions to Hospitals Treating Whipple's disease
What to expect (Outlook/Prognosis)
Without treatment, the condition is usually fatal. Treatment relieves symptoms and can cure the disease.
Possible Complications
- Brain damage
- Heart valve damage (from endocarditis)
- Nutritional deficiencies
- Weight loss
- Symptoms return (which may be because of drug resistance)
Sources
- http://digestive.niddk.nih.gov/ddiseases/pubs/whipple/index.htm
- http://www.nlm.nih.gov/medlineplus/ency/article/000209.htm