Whipple's disease differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Whipple's disease}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Whipple%27s_disease]]
 
{{CMG}}; {{AE}} {{SSH}}
{{CMG}}; {{AE}} {{SSH}}
==Overview==
==Overview==
Whipple's disease must be differentiated from other diseases that cause [[malabsorption]], [[chronic diarrhea]], multi system involvement, such as [[Celiac disease]], [[systemic infections]], and [[inflamatory bowel disease]].
Whipple's disease must be differentiated from other diseases that cause [[malabsorption]], [[chronic diarrhea]], multisystem involvement, such as [[celiac disease]], [[cystic fibrosis]], [[inflammatory bowel disease]] and systemic [[infections]].


==Differentiating Whipple's disease from other Diseases==
==Differentiating Whipple's disease from other Diseases==
Whipple's disease must be differentiated from other diseases that cause [[malabsorption]], [[chronic diarrhea]], joins involvement, and neurologic symptoms.
Whipple's disease must be differentiated from other diseases that cause [[malabsorption]], [[chronic diarrhea]], [[abdominal pain]] and multisystem involvement.<ref name="pmid8694025">{{cite journal| author=Hertzler SR, Savaiano DA| title=Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance. | journal=Am J Clin Nutr | year= 1996 | volume= 64 | issue= 2 | pages= 232-6 | pmid=8694025 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8694025  }} </ref><ref name="pmid9414969">{{cite journal| author=Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC| title=Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect? | journal=Gut | year= 1997 | volume= 41 | issue= 5 | pages= 632-5 | pmid=9414969 | doi= | pmc=1891556 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9414969  }} </ref><ref name="pmid15391722">{{cite journal| author=BLACK-SCHAFFER B| title=The tinctoral demonstration of a glycoprotein in Whipple's disease. | journal=Proc Soc Exp Biol Med | year= 1949 | volume= 72 | issue= 1 | pages= 225-7 | pmid=15391722 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15391722  }} </ref><ref name="pmid14201408">{{cite journal| author=SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA| title=EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME. | journal=Gastroenterology | year= 1964 | volume= 47 | issue=  | pages= 184-7 | pmid=14201408 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14201408  }} </ref><ref name="pmid16151544">{{cite journal| author=Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR et al.| title=Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. | journal=Can J Gastroenterol | year= 2005 | volume= 19 Suppl A | issue=  | pages= 5A-36A | pmid=16151544 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16151544  }}</ref><ref name="pmid12135027">{{cite journal| author=Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D| title=Bowel habits and bile acid malabsorption in the months after cholecystectomy. | journal=Am J Gastroenterol | year= 2002 | volume= 97 | issue= 7 | pages= 1732-5 | pmid=12135027 | doi=10.1111/j.1572-0241.2002.05779.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12135027  }}</ref><ref name="pmid1702075">{{cite journal| author=Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R et al.| title=Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia. | journal=Gastroenterology | year= 1991 | volume= 100 | issue= 2 | pages= 359-69 | pmid=1702075 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1702075  }}</ref><ref name="pmid14439871">{{cite journal| author=RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC| title=Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue. | journal=Gastroenterology | year= 1960 | volume= 38 | issue=  | pages= 28-49 | pmid=14439871 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14439871  }}</ref><ref name="StreetDonoghue1999">{{cite journal|last1=Street|first1=Sara|last2=Donoghue|first2=Helen D|last3=Neild|first3=GH|title=Tropheryma whippelii DNA in saliva of healthy people|journal=The Lancet|volume=354|issue=9185|year=1999|pages=1178–1179|issn=01406736|doi=10.1016/S0140-6736(99)03065-2}}</ref><ref name="pmid8903578">{{cite journal |vauthors=Marth T, Strober W |title=Whipple's disease |journal=Semin. Gastrointest. Dis. |volume=7 |issue=1 |pages=41–8 |year=1996 |pmid=8903578 |doi= |url=}}</ref><ref name="SchneiderMoos2008">{{cite journal|last1=Schneider|first1=Thomas|last2=Moos|first2=Verena|last3=Loddenkemper|first3=Christoph|last4=Marth|first4=Thomas|last5=Fenollar|first5=Florence|last6=Raoult|first6=Didier|title=Whipple's disease: new aspects of pathogenesis and treatment|journal=The Lancet Infectious Diseases|volume=8|issue=3|year=2008|pages=179–190|issn=14733099|doi=10.1016/S1473-3099(08)70042-2}}</ref>
* [[Malabsorption]] with [[small intestine]] involvement ([[celiac disease]], [[sarcoidosis]], and [[lymphoma]])
* [[Infection|Infections]] such as [[tuberculosis]], endemic [[Fungus|fungi]] (eg, [[Histoplasma capsulatum|Histoplasma]] spp), [[Rhodococcus]] and [[Human Immunodeficiency Virus (HIV)|HIV]] infection
* [[Inflammatory bowel disease|Inflammatory bowel diseases]]
*[[Connective tissue disease|Connective tissue diseases]]
*Neurologic disease
*[[Addison's disease]]
The following diseases have presentations similar to that of Whipple's disease.


'''The table below summarizes the diseases that cause [[malabsorption]], [[diarrhea]] and [[abdominal pain]].'''<ref name="pmid8694025">{{cite journal| author=Hertzler SR, Savaiano DA| title=Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance. | journal=Am J Clin Nutr | year= 1996 | volume= 64 | issue= 2 | pages= 232-6 | pmid=8694025 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8694025  }} </ref><ref name="pmid9414969">{{cite journal| author=Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC| title=Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect? | journal=Gut | year= 1997 | volume= 41 | issue= 5 | pages= 632-5 | pmid=9414969 | doi= | pmc=1891556 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9414969  }} </ref><ref name="pmid15391722">{{cite journal| author=BLACK-SCHAFFER B| title=The tinctoral demonstration of a glycoprotein in Whipple's disease. | journal=Proc Soc Exp Biol Med | year= 1949 | volume= 72 | issue= 1 | pages= 225-7 | pmid=15391722 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15391722  }} </ref><ref name="pmid14201408">{{cite journal| author=SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA| title=EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME. | journal=Gastroenterology | year= 1964 | volume= 47 | issue=  | pages= 184-7 | pmid=14201408 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14201408  }} </ref><ref name="pmid16151544">{{cite journal| author=Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR et al.| title=Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. | journal=Can J Gastroenterol | year= 2005 | volume= 19 Suppl A | issue=  | pages= 5A-36A | pmid=16151544 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16151544  }}</ref><ref name="pmid12135027">{{cite journal| author=Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D| title=Bowel habits and bile acid malabsorption in the months after cholecystectomy. | journal=Am J Gastroenterol | year= 2002 | volume= 97 | issue= 7 | pages= 1732-5 | pmid=12135027 | doi=10.1111/j.1572-0241.2002.05779.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12135027  }}</ref><ref name="pmid1702075">{{cite journal| author=Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R et al.| title=Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia. | journal=Gastroenterology | year= 1991 | volume= 100 | issue= 2 | pages= 359-69 | pmid=1702075 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1702075  }}</ref><ref name="pmid14439871">{{cite journal| author=RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC| title=Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue. | journal=Gastroenterology | year= 1960 | volume= 38 | issue=  | pages= 28-49 | pmid=14439871 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14439871  }}</ref>
'''The table below summarizes the diseases that cause [[malabsorption]], [[diarrhea]] and [[abdominal pain]].'''


<span style="font-size:85%">'''Abbreviations:'''
<span style="font-size:85%">'''Abbreviations:'''
'''WBC:''' [[White blood cells]]; '''Plt:''' [[Platelet|Platelets]], '''Hgb:''' [[Hemoglobin]], '''IgE:''' [[Immunoglobulin E]], '''IgA:''' [[Immunoglobulin A]]  
'''WBC:''' [[White blood cells]]; '''Plt:''' [[Platelet|Platelets]], '''Hgb:''' [[Hemoglobin]], '''IgE:''' [[Immunoglobulin E]], '''IgA:''' [[Immunoglobulin A]]  
</span>
</span>
<small>
<small><small>
{| style="border: 0px; font-size: 100%; margin: 3px;" align=center
{| style="border: 0px; font-size: 100%; margin: 3px;" align="center"
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Cause
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Cause
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Peak age of onset
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Peak age of onset
Line 32: Line 24:
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Gold standard diagnosis
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Gold standard diagnosis
|-
|-
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Fever
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Abdominal pain
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Diarrhea
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Diarrhea
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Fever
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Abdominal pain
|-
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" |Watery
! align="center" style="background:#4479BA; color: #FFFFFF;" |Watery
Line 45: Line 37:
|-
|-
! align="center" style="background:#DCDCDC;" |Whipple's disease
! align="center" style="background:#DCDCDC;" |Whipple's disease
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |50th
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |40-60
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
Line 54: Line 46:
* [[Ocular motility disorders|Abnormal extraocular movement]]
* [[Ocular motility disorders|Abnormal extraocular movement]]
* [[Lymphadenopathy]]
* [[Lymphadenopathy]]
* [[Pleural effusion]]
* [[Hyperpigmentation]]
* [[Hyperpigmentation]]
* Decreased breathing sound
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
Line 68: Line 60:
* [[Hepatosplenomegaly]]
* [[Hepatosplenomegaly]]
* [[Ascites]]
* [[Ascites]]
* [[Arthritis]]
* [[Pleural effusion]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Tropheryma whipplei]]
* [[Tropheryma whipplei]]
* HLA
* [[HLA-B27]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Small intestine]] [[biopsy]] for [[Tropheryma whipplei]] testing  
* [[Small intestine]] [[biopsy]] for [[Tropheryma whipplei]] testing
* [[PCR]] testing
|-
|-
! align="center" style="background:#DCDCDC;" |[[Celiac disease]]
! align="center" style="background:#DCDCDC;" |[[Celiac disease]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Childhood
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Childhood
Adult
Adult
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
Line 88: Line 80:
* [[Tetany]]
* [[Tetany]]
* [[Mouth ulcers]]
* [[Mouth ulcers]]
* [[Dermatitis herpetiformis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ↓
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ↓
Line 101: Line 92:
* [[Hepatosplenomegaly]]
* [[Hepatosplenomegaly]]
* [[Ascites]]
* [[Ascites]]
* [[Dermatitis herpetiformis]]
* Must follow [[Gluten-free diet]]
* Must follow [[Gluten-free diet]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[HLA-DQ2]] 
* [[HLA-DQ2]]
* [[HLA-DQ8]]  
* [[HLA-DQ8]]
* Innate responses to [[wheat proteins]]
* Innate responses to [[wheat proteins]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[IgA]] endomysial antibody
* [[IgA]] endomysial antibody
* [[IgA]] tissue transglutaminase antibody
* [[IgA]] tissue transglutaminase antibody
|
|-
|-
! align="center" style="background:#DCDCDC;" |Grain allergy
! align="center" style="background:#DCDCDC;" |[[Cystic fibrosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Childhood
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Childhood
Adult
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Vomiting]]
* [[Abdominal distension|Abdominal distention]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Elevated [[IgE|IgE levels]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Atopic dermatitis]]
* [[Dysphagia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Abnormal [[immune response]] to wheat [[antigens]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Measurement of grain-specific [[IgE|immunoglobulin E (IgE)]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|-
! align="center" style="background:#DCDCDC;" |[[Cystic fibrosis]]
| align="center" style="background:#F5F5F5;" | Infancy and childhood
| align="center" | -
| align="center" | +
| align="center" |
| align="center" | +
| align="center" | +
|
* [[Digital clubbing]]
* [[Digital clubbing]]
* [[Rales|Respiratory rale]], [[wheeze]], and [[Crackles|crackle]]
* Abnormal [[breathing sounds]]
* [[Abdominal pain]]
* [[Cyanosis]]
* [[Cyanosis]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Positive [[DNA]] analysis for [[CFTR]] multimutation method
* Positive [[DNA]] analysis for [[CFTR]]
* Evaluated [[nasal]] transepithelial potential difference (NPD)
* Evaluated [[nasal]] transepithelial potential difference (NPD)
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Disease manifestations in multiple organ systems:
* [[Diabetes]]
** [[Diabetes]]
* Recurrent upper and lower [[respiratory tract infections]]
** Recurrent upper and lower [[Respiratory tract infections|respiratory tract infections]]
* [[Infertility]]
** [[Infertility]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|
* Mutations in the [[cystic fibrosis transmembrane conductance regulator]] ([[CFTR]]) protein
* Mutations in the [[cystic fibrosis transmembrane conductance regulator]] ([[CFTR]]) protein
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Elevated [[Sweat chloride test|sweat chloride]] ≥60 mmol/L
* Elevated [[Sweat chloride test|sweat chloride]] ≥60 mmol/L
|
|-
|-
! align="center" style="background:#DCDCDC;" |[[Lactose intolerance]]
! align="center" style="background:#DCDCDC;" |[[Crohns disease]]
| align="center" style="background:#F5F5F5;" | Adult
| align="center" | +
| align="center" | -
| align="center" |
| align="center" | -
| align="center" | +
|
* [[Abdominal tenderness]]
|
|
|
|
* Stool [[osmotic]] gap of >125 mOsm/kg 
* Stool [[pH]] <6 
|
* Avoidance of [[Dietary|dietary]]<nowiki/> [[lactose]]
* Maintenance of [[nutrient]] intake
* Regulation of [[calcium]] intake
* Use of [[enzyme]] [[lactase]]
|
* Acquired primary [[lactase deficiency]]
** Adult-type [[hypolactasia]]
** Inability to produce persistent[[Lactase]]
|
* [[Hydrogen Breath Test|Lactose breath hydrogen test]]
|
|-
! align="center" style="background:#DCDCDC;" |[[Crohns disease|Crohns disease]]
| align="center" style="background:#F5F5F5;" | Young adults
| align="center" style="background:#F5F5F5;" | Young adults
(20th)
(20th)
| align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Abdominal]] [[tenderness ]]when palpated in severe [[disease]]
* [[Abdominal tenderness]]
* [[Tachycardia]]
* [[Tachycardia]]
*[[Hypotension]]
* [[Hypotension]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Anemia]]
* [[Iron deficiency]]
* [[Iron deficiency]]
* Elevated [[white blood cell count]]
* [[Vitamin B12]] deficiency
* [[Vitamin B12]] deficiency
* Elevated [[erythrocyte sedimentation rate]]  
* Elevated [[erythrocyte sedimentation rate|ESR]]  
* Elevated [[C-reactive protein|CRP]]
* Elevated [[C-reactive protein|CRP]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Blood seen on [[rectal exam]]
* Blood seen on [[rectal exam]]
* [[Fever]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|
* Abnormal immune response to self [[antigens]]
* Abnormal immune response to self [[antigens]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Colonoscopy]] with [[biopsy]]
* [[Colonoscopy]] with [[biopsy]]
|
|-
! align="center" style="background:#DCDCDC;" |[[Laxative abuse|Laxative overuse]]
| align="center" style="background:#F5F5F5;" | After childhood
| align="center" | +
| align="center" | -
| align="center" |
| align="center" |<nowiki>+/-</nowiki>
| align="center" | +/-
|
* Enhanced [[gastrointestinal]] motility and [[gastrointestinal]] sound
* Mild [[abdominal tenderness]]
* [[Abdominal distension|Abdominal bloating]]
|
|
|
|
* [[Hypokalemia]] 
* [[Metabolic alkalosis]]
* [[Hypermagnesemia]](in case of [[magnesium]] [[laxative]] usage)
|<nowiki>-</nowiki>
|
* [[Laxative]] drug abuse
|
* [[Laxatives|Laxative]] screening on a stool for:
** [[Laxatives|Diphenolic laxatives]] (eg, [[bisacodyl]])
** [[Polyethylene glycol|Polyethylene glyco]]<nowiki/>l-containing [[laxatives]]
|
|-
! align="center" style="background:#DCDCDC;" |[[Hyperthyroidism]]
| align="center" style="background:#F5F5F5;" | Any age
| align="center" | +
| align="center" | -
| align="center" |
| align="center" |<nowiki>+</nowiki>
| align="center" |<nowiki>+/-</nowiki>
|
* Lump in the neck
* [[Proptosis]]
* [[Tremors]]
* Increased [[Deep tendon reflex|DTR]]
|
|
|
|
* Elevated [[T4]]
* Elevated [[T3]]
* Decreased level of [[TSH]]
|
* Lid lag
* [[Sweating]]
* [[Hyperpigmentation]]
|
* [[Graves' disease]]
* [[Hashimoto's thyroiditis|Hashimoto thyroiditis]]
* [[Toxic Adenoma|Toxic adenoma]]
|
* [[TSH]]
|
|-
|-
! align="center" style="background:#DCDCDC;" |[[Irritable bowel syndrome]]
! align="center" style="background:#DCDCDC;" |[[Irritable bowel syndrome]]
| align="center" style="background:#F5F5F5;" | Between 30 and 50
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |30-50
| align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| align="center" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* [[Abdominal tenderness]]
* [[Abdominal tenderness]]
* [[Flatulence]]
* Hard stool in the rectal vault
* Hard stool in the rectal vault
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| align="center" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
* [[Bloating|Bloating]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
* [[Flatulence]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
|
* Diagnosis of exclusion
* Postinfectious
* [[Inflammatory]]
|
* [[Diagnosis|Clinical diagnosis]]
** ROME III criteria
** [[Pharmacological|Pharmacologic]] studies based criteria
|
|-
|-
! align="center" style="background:#DCDCDC;" |[[VIPoma]]
! align="center" style="background:#DCDCDC;" |[[VIPoma]]
| align="center" style="background:#F5F5F5;" | Between 30 and 50
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |30-50
| +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" |<nowiki>+/-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|
| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |  
* [[Tachycardia]]  
* [[Tachycardia]]  
* [[Rash]]  
* [[Rash]]  
* [[Facial flushing]]  
* [[Facial flushing]]  
* [[Abdominal distention]]
* [[Abdominal distention]]
* [[Abdominal tenderness]] in the right upper abdominal quadrant
* Abdominal RUQ tenderness
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Elevated [[VIP]] level
*[[Hypokalemia]]
*[[Hypokalemia]]
*[[Hypochlorhydria]] or [[achlorhydria]]
*[[Hypochlorhydria]] or [[achlorhydria]]
*Low osmotic gap (<50 mOsm/kg)
*Low osmotic gap (<50 mOsm/kg)
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* [[Dehydration]]  
* [[Dehydration]]  
* [[Lethargy]], [[muscle weakness]]
* [[Lethargy]]
* [[Nausea]], [[vomiting]]
* [[Muscle weakness]]
* [[Flushing]]
* [[Nausea]]
|
* [[Vomiting]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* Primary secretory tumor
* Primary secretory tumor
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* Elevated [[VIP]] levels
* Elevated [[VIP]] levels
* Followed by imaging
* Followed by imaging
|
|-
|-
! align="center" style="background:#DCDCDC;" |[[Gastrinoma]] ([[Zollinger-Ellison syndrome|Zollinger-Ellison syndrome]])
! align="center" style="background:#DCDCDC;" |[[Zollinger-Ellison syndrome]]
| align="center" style="background:#F5F5F5;" | Between the ages of 20 and 50
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |20-50
| align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|
| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
* Mild to moderate upper [[abdominal tenderness]]
* [[Abdominal tenderness]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* Positive [[secretin]] stimulation test
* Positive [[secretin]] stimulation test
* Elevated serum [[chromogranin A]]
* Elevated serum [[chromogranin A]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* [[Heartburn]]
* [[Heartburn]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* [[Gastrin]] producing tumor mainly in [[duodenum]]
* [[Gastrin]] producing [[tumor]] mainly in [[duodenum]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* Elevated basal or stimulated serum [[gastrin]] more than 1000 pg/mL
* Elevated basal or stimulated serum [[gastrin]]> 120 pg/mL
|
|-
|-
! align="center" style="background:#DCDCDC;" |[[Lactose intolerance]]
! align="center" style="background:#DCDCDC;" |[[Lactose intolerance]]
| align="center" style="background:#F5F5F5;" | Any age
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Any age
| align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| align="center" |<nowiki>+/-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* [[Abdominal]] [[tenderness ]]when palpated in severe [[disease]]
* [[Abdominal tenderness ]]
* [[Fever]]
* [[Hypotension]]
* [[Hypotension]]
* [[Tachycardia]]
* [[Tachycardia]]
* [[Nausea and vomiting]]
* [[Nausea and vomiting]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* [[Hydrogen Breath Test|Lactose breath hydrogen test]]
* [[Hydrogen breath test]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* [[Bloating|Bloating]]
* [[Bloating]]
* [[Flatulence]]
* [[Flatulence]]
* Symptoms begin mainly after ingestion of [[lactose]]
* Symptoms begin mainly after ingestion of [[lactose]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* Reduction of lactase enzyme activity or in ability to produce persistent [[lactase]]  
* Reduction of lactase enzyme activity or inability to produce persistent [[lactase]]  
* Congenital [[lactase deficiency]]
* Congenital [[lactase deficiency]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* [[Lactase]] activity assay
* [[Lactase]] activity assay
|
|-
! align="center" style="background:#DCDCDC;" |Allergic enteropathy/Food protein-induced enterocolitis syndrome (FPIES)
| align="center" style="background:#F5F5F5;" | Infancy
| align="center" | +
| align="center" | -
| align="center" |
| align="center" | +/-
| align="center" | +
|
* [[Nausea]]
* [[Vomiting]]
* [[Abdominal distention]]
|
|
|
|[[Stool examination|Stool examination:]]
* Blood-tinged and mucusy
* [[Polymorphonuclear leukocytes]] presence
|
* Triggered by cow milk protein
* Profuse, repetitive [[vomiting]]
|
* [[Autoimmunity|Autoimmune]]/[[Allergy|allergic]] response to food [[antigens]]
|
* [[Oral]] food challenge (OFC)
|
|-
|-
! align="center" style="background:#DCDCDC;" |[[Eosinophilic gastroenteritis]] 
! align="center" style="background:#DCDCDC;" |[[Eosinophilic gastroenteritis]] 
| align="center" style="background:#F5F5F5;" | 30th
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | 30th
| align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* [[Nausea]]
* [[Vomiting]]
* [[Abdominal distention]]
* [[Abdominal distention]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ↑
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* Elevated [[serum]] [[IgE]] levels
* Elevated [[serum]] [[IgE]] levels
* Abnormal [[D-xylose]] test
* [[Eosinophilia]]
|
* Elevated [[ESR]]
* One-half of patients have other [[Allergic disorders|allergic diseases]]
* [[Hypoalbuminemia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* Other [[Allergic disorders|allergic disorders]]
* Associated with an identifiable [[dietary]] [[antigen]]
* Associated with an identifiable [[dietary]] [[antigen]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* [[Autoimmunity|Autoimmune]]/[[Allergy|allergic]] response to food [[antigens]]
* [[Autoimmunity|Autoimmune]] [[Allergy|allergic]] response to food [[antigens]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* [[Eosinophilic]] infiltration of the [[gastrointestinal tract]] on [[biopsy]]
* [[Eosinophilic]] infiltration of the [[gastrointestinal tract]] on [[biopsy]]
|
|-
|-
! align="center" style="background:#DCDCDC;" |Primary bile acid malabsorption
! align="center" style="background:#DCDCDC;" |[[Primary bile acid malabsorption]]
| align="center" style="background:#F5F5F5;" | Childhood Adolescents
| align="center" style="background:#F5F5F5;" | Childhood Adult
| align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| align="center" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|
 
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* Low  [[Vitamin A|vitamins A]], [[Vitamin D|D]], E, and K  
* Low  [[Vitamin A|vitamins A]], [[Vitamin D|D]], E, and K  
* [[Anemia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|
 
* Disease hetergenicity lead to varying presentation from chronic [[diarrhea]] without significant fat [[Malabsorption|malabsorption]] to severe [[watery diarrhea]] and steatorrhea with [[malnutrition]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|
* [[Genetic defects]] in ''SLC10A2'' (solute carrier family 10 member 2 gene)
* [[Genetic defects]] in ''SLC10A2'' (solute carrier family 10 member 2 gene)
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Total and specific [[bile acid]]<nowiki/>s from stool
* Elevated total and specific [[bile acids]] in stool
* [[Gamma emitter selenium-75-homocholic acid taurine]] (SeHCAT)
* Positive [[SeHCAT]]
|
|-
|-
! align="center" style="background:#DCDCDC;" |[[Abetalipoproteinemia]]
! align="center" style="background:#DCDCDC;" |[[Abetalipoproteinemia]]
| align="center" style="background:#F5F5F5;" | Infancy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Infancy
| align="center" | -
Adult
| align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
* [[Abdominal distension|Abdominal distention]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Impaired [[visual acuity]] and [[Visual field defect|visual field defects]]
* [[Abdominal distension]]
* [[Visual field defect]]
* [[Dysarthria]]
* [[Dysarthria]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Low [[triglyceride]]
* Low [[triglyceride]]
* Low total [[cholesterol]] levels 
* Low total [[cholesterol]] levels 
* [[Acanthocytes]]
* [[Acanthocytes]]
* Low [[vitamin E]] levels
* Low [[vitamin E]] levels
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Clumsiness]]
* Visual impairment
* Vision impairment
* [[Ataxia]]
* [[Ataxia]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Autosomal recessive]] disorder caused by mutations encoding the [[microsomal]] [[triglyceride]] transfer protein (MTP)
* [[Autosomal recessive]] disorder caused by mutations encoding the [[microsomal]] [[triglyceride]] transfer protein (MTP)
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Clinical findings and low [[triglyceride]] and [[cholesterol]] level
* Clinical findings and low [[triglyceride]] and [[cholesterol]] level
|
|-
|-
! align="center" style="background:#DCDCDC;" |[[Microscopic colitis]]
! align="center" style="background:#DCDCDC;" |[[Microscopic colitis]]
| align="center" style="background:#F5F5F5;" | 60th
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |50-70
| align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Abdominal tenderness]]
* [[Abdominal tenderness]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Elevated [[autoantibodies]] include:
* Elevated [[autoantibodies]] include:
** [[RF]]
**[[RF]]
** [[ANA]]
**[[ANA]]
** [[Anti-mitochondrial antibody|AMA]]
**[[Anti-mitochondrial antibody|AMA]]
** [[ANCA]]
**[[ANCA]]
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Fecal urgency
* Fecal urgency
* [[Incontinence]]
* Fecal [[incontinence]]
* May be associated with extraintestinal symptoms, such as:
* [[Arthralgia]]
** [[Arthralgia]]
* [[Arthritis]]
** [[Arthritis]]
* [[Uveitis]]
** [[Uveitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|
* [[Mucosal]] [[immune responses]] to luminal factors in a genetically predisposed individual
* [[Mucosal]] [[immune responses]] to luminal factors in a genetically predisposed individual
|
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* A [[colonoscopy]] with [[mucosal]] [[biopsy]] with mononuclear infiltrates:
* [[Colonoscopy]] with [[mucosal]] [[biopsy]] with [[mononuclear]] infiltrates:
** [[Collagenous colitis]] is characterized by a colonic subepithelial [[collagen]] band >10 micrometers in diameter
** [[Collagenous colitis]] is characterized by a colonic subepithelial [[collagen]] band >10 micrometers in diameter
** [[Lymphocytic]] [[colitis]] is characterized by ≥20 intraepithelial [[lymphocytes]] (IEL) per 100 surface epithelial cells
** [[Lymphocytic]] [[colitis]] is characterized by ≥20 intraepithelial [[lymphocytes]] (IEL) per 100 surface epithelial cells
|
|-
! align="center" style="background:#DCDCDC;" |[[Hyperthyroidism]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any age
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Lump in the neck
* [[Proptosis]]
* [[Tremor]]
* Increased [[Deep tendon reflex|DTR]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Elevated [[T4]]
* Elevated [[T3]]
* Decreased [[TSH]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Lid lag
* [[Sweating]]
* [[Hyperpigmentation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Graves' disease]]
* [[Hashimoto's thyroiditis]]
* [[Toxic adenoma]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[TSH]]
|-
! align="center" style="background:#DCDCDC;" |Grain allergy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Childhood
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
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* [[Vomiting]]
* [[Abdominal distension]]
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* Elevated [[IgE]]
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* [[Atopic dermatitis]]
* [[Dysphagia]]
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* Abnormal [[immune response]] to wheat [[antigens]]
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* Measurement of grain-specific [[IgE|immunoglobulin E (IgE)]]
|}
|}
</small>
</small></small>


==References==
==References==
{{reflist|2}}
{{reflist|2}}
 
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[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Infectious disease]]
[[Category:Up-To-Date]]

Latest revision as of 00:44, 30 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

Whipple's disease must be differentiated from other diseases that cause malabsorption, chronic diarrhea, multisystem involvement, such as celiac disease, cystic fibrosis, inflammatory bowel disease and systemic infections.

Differentiating Whipple's disease from other Diseases

Whipple's disease must be differentiated from other diseases that cause malabsorption, chronic diarrhea, abdominal pain and multisystem involvement.[1][2][3][4][5][6][7][8][9][10][11]

The table below summarizes the diseases that cause malabsorption, diarrhea and abdominal pain.

Abbreviations: WBC: White blood cells; Plt: Platelets, Hgb: Hemoglobin, IgE: Immunoglobulin E, IgA: Immunoglobulin A

Cause Peak age of onset History Physical exam Lab findings Additional findings Cause/Pathogenesis Gold standard diagnosis
Fever Abdominal pain Diarrhea Weight loss
Watery Fatty WBC Hgb Plt Other lab findings
Whipple's disease 40-60 ± + + + + ↓/↑
Celiac disease Childhood

Adult

- + +/- +/- + - -
  • IgA endomysial antibody
  • Anti-tissue transglutaminase antibody
  • Anti-gliadin antibody
  • IgA endomysial antibody
  • IgA tissue transglutaminase antibody
Cystic fibrosis Childhood

Adult

± + - + + - -
  • Positive DNA analysis for CFTR
  • Evaluated nasal transepithelial potential difference (NPD)
Crohns disease Young adults

(20th)

+ + + + +
  • Abnormal immune response to self antigens
Irritable bowel syndrome 30-50 - ± ± ± - - - -
  • Diagnosis of exclusion
VIPoma 30-50 - + + + + - - -
  • Primary secretory tumor
  • Elevated VIP levels
  • Followed by imaging
Zollinger-Ellison syndrome 20-50 - + + + + - -
  • Elevated basal or stimulated serum gastrin> 120 pg/mL
Lactose intolerance Any age - + + - - - - -
Eosinophilic gastroenteritis  30th - + + + + - -
Primary bile acid malabsorption Childhood Adult - + + + + - -
Abetalipoproteinemia Infancy

Adult

- + + + + - - -
Microscopic colitis 50-70 - + + - + - -
Hyperthyroidism Any age ± + + - + - - -
  • Elevated T4
  • Elevated T3
  • Decreased TSH
Grain allergy Childhood - + + - + - - -

References

  1. Hertzler SR, Savaiano DA (1996). "Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance". Am J Clin Nutr. 64 (2): 232–6. PMID 8694025.
  2. Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC (1997). "Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect?". Gut. 41 (5): 632–5. PMC 1891556. PMID 9414969.
  3. BLACK-SCHAFFER B (1949). "The tinctoral demonstration of a glycoprotein in Whipple's disease". Proc Soc Exp Biol Med. 72 (1): 225–7. PMID 15391722.
  4. SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA (1964). "EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME". Gastroenterology. 47: 184–7. PMID 14201408.
  5. Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR; et al. (2005). "Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology". Can J Gastroenterol. 19 Suppl A: 5A–36A. PMID 16151544.
  6. Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D (2002). "Bowel habits and bile acid malabsorption in the months after cholecystectomy". Am J Gastroenterol. 97 (7): 1732–5. doi:10.1111/j.1572-0241.2002.05779.x. PMID 12135027.
  7. Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R; et al. (1991). "Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia". Gastroenterology. 100 (2): 359–69. PMID 1702075.
  8. RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC (1960). "Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue". Gastroenterology. 38: 28–49. PMID 14439871.
  9. Street, Sara; Donoghue, Helen D; Neild, GH (1999). "Tropheryma whippelii DNA in saliva of healthy people". The Lancet. 354 (9185): 1178–1179. doi:10.1016/S0140-6736(99)03065-2. ISSN 0140-6736.
  10. Marth T, Strober W (1996). "Whipple's disease". Semin. Gastrointest. Dis. 7 (1): 41–8. PMID 8903578.
  11. Schneider, Thomas; Moos, Verena; Loddenkemper, Christoph; Marth, Thomas; Fenollar, Florence; Raoult, Didier (2008). "Whipple's disease: new aspects of pathogenesis and treatment". The Lancet Infectious Diseases. 8 (3): 179–190. doi:10.1016/S1473-3099(08)70042-2. ISSN 1473-3099.

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