Whipple's disease differential diagnosis: Difference between revisions

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


<small><small>
<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>
{| style="border: 0px; font-size: 100%; margin: 3px;" align=center
<small><small>
{| 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
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| 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" |
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* [[IgA]] endomysial antibody
* [[IgA]] endomysial antibody
* [[IgA]] tissue transglutaminase antibody
* [[IgA]] tissue transglutaminase antibody
|-
! align="center" style="background:#DCDCDC;" |[[Cystic fibrosis]]
| 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="left" |
* [[Digital clubbing]]
* Abnormal [[breathing sounds]]
* [[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]]
* Evaluated [[nasal]] transepithelial potential difference (NPD)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Diabetes]]
* Recurrent upper and lower [[respiratory tract infections]]
* [[Infertility]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* 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
|-
|-
! align="center" style="background:#DCDCDC;" |[[Crohns disease]]
! align="center" style="background:#DCDCDC;" |[[Crohns disease]]
| align="center" style="background:#F5F5F5;" | Young adults
| align="center" style="background:#F5F5F5;" | Young adults
(20th)
(20th)
| 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" |
* [[Abdominal tenderness]]
* [[Abdominal tenderness]]
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* [[Colonoscopy]] with [[biopsy]]
* [[Colonoscopy]] with [[biopsy]]
|-
|-
! align="center" style="background:#DCDCDC;" |[[Cystic fibrosis]]
! align="center" style="background:#DCDCDC;" |[[Irritable bowel syndrome]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Childhood
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |30-50
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="left" |  
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
* [[Abdominal tenderness]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |+
* [[Flatulence]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Hard stool in the rectal vault
* [[Digital clubbing]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
* Abnormal [[breathing sounds]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
* [[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="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" |  
* Positive [[DNA]] analysis for [[CFTR]]
* Diagnosis of exclusion
* Evaluated [[nasal]] transepithelial potential difference (NPD)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Diabetes]]
* Recurrent upper and lower [[respiratory tract infections]]
* [[Infertility]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* 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
|-
|-
! align="center" style="background:#DCDCDC;" |[[VIPoma]]
! align="center" style="background:#DCDCDC;" |[[VIPoma]]
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* [[Abdominal distention]]
* [[Abdominal distention]]
* Abdominal RUQ tenderness
* 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="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" |
*Elevated [[VIP]] level
*Elevated [[VIP]] level
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! align="center" style="background:#DCDCDC;" |[[Zollinger-Ellison syndrome]]
! align="center" style="background:#DCDCDC;" |[[Zollinger-Ellison syndrome]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |20-50
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |20-50
| 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" |
* [[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="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" |  
* Positive [[secretin]] stimulation test
* Positive [[secretin]] stimulation test
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* Elevated basal or stimulated serum [[gastrin]]> 120 pg/mL
* Elevated basal or stimulated serum [[gastrin]]> 120 pg/mL
|-
|-
 
! align="center" style="background:#DCDCDC;" |[[Lactose intolerance]]
| 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" |
* [[Abdominal tenderness ]]
* [[Hypotension]]
* [[Tachycardia]]
* [[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]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Bloating]]
* [[Flatulence]]
* Symptoms begin mainly after ingestion of [[lactose]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Reduction of lactase enzyme activity or inability to produce persistent [[lactase]]
* Congenital [[lactase deficiency]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Lactase]] activity assay
|-
! align="center" style="background:#DCDCDC;" |[[Eosinophilic gastroenteritis]] 
! align="center" style="background:#DCDCDC;" |[[Eosinophilic gastroenteritis]] 
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | 30th
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | 30th
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! align="center" style="background:#DCDCDC;" |[[Primary bile acid malabsorption]]
! align="center" style="background:#DCDCDC;" |[[Primary bile acid malabsorption]]
| align="center" style="background:#F5F5F5;" | Childhood Adult
| align="center" style="background:#F5F5F5;" | 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" |


| 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" |  
* Low  [[Vitamin A|vitamins A]], [[Vitamin D|D]], E, and K  
* Low  [[Vitamin A|vitamins A]], [[Vitamin D|D]], E, and K  
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Infancy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Infancy
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" |
* [[Abdominal distension]]
* [[Abdominal distension]]
* [[Visual field defect]]
* [[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="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" |
* Low [[triglyceride]]
* Low [[triglyceride]]
Line 295: Line 341:
! align="center" style="background:#DCDCDC;" |[[Microscopic colitis]]
! align="center" style="background:#DCDCDC;" |[[Microscopic colitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |50-70
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |50-70
| 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" |
* [[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="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" |
* Elevated [[autoantibodies]] include:
* Elevated [[autoantibodies]] include:
Line 327: Line 373:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any age
| 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="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" |
* Lump in the neck
* Lump in the neck
Line 336: Line 382:
* [[Tremor]]
* [[Tremor]]
* Increased [[Deep tendon reflex|DTR]]
* 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="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" |
* Elevated [[T4]]
* Elevated [[T4]]
Line 354: Line 400:
* [[TSH]]
* [[TSH]]
|-
|-
! align="center" style="background:#DCDCDC;" |[[Lactose intolerance]]
! align="center" style="background:#DCDCDC;" |Grain allergy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Any age
| 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" | +
| 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" |  
* [[Abdominal tenderness ]]
* [[Vomiting]]
* [[Hypotension]]
* [[Abdominal distension]]
* [[Tachycardia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
* [[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="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" |  
* [[Hydrogen breath test]]
* Elevated [[IgE]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |  
* [[Bloating]]
* [[Atopic dermatitis]]
* [[Flatulence]]
* [[Dysphagia]]
* Symptoms begin mainly after ingestion of [[lactose]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Reduction of lactase enzyme activity or inability to produce persistent [[lactase]]
* Congenital [[lactase deficiency]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Lactase]] activity assay
|-
! align="center" style="background:#DCDCDC;" |[[Irritable bowel syndrome]]
| 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" |±
| 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" |  
* [[Abdominal tenderness]]
* Abnormal [[immune response]] to wheat [[antigens]]
* [[Flatulence]]
* 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" | -
| 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" |  
* Diagnosis of exclusion
* Measurement of grain-specific [[IgE|immunoglobulin E (IgE)]]
|-}
|}
</small></small>
</small></small>



Revision as of 15:53, 12 November 2017

Whipple's disease Microchapters

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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, multi system involvement, such as Celiac disease, systemic infections, and inflamatory bowel disease.

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.[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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