Whipple's disease

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at October 1, 2016
StartWhipple's disease

Whipple's disease is a type of gastrointestinal disease caused by bacteria, and it usually affects the small intestine though can spread to other organs. It is life-threatening if left untreated. It is not a common disease; less than 1,000 cases have been reported.

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Definition & Facts

Whipple's disease is a bacterial infection which commonly affects the gastrointestinal system and its surrounding areas. This type of infection is rare. In addition to the gastrointestinal tract, it can cause infection of the eyes, joints, heart, and even brain.

It interferes with digestive processes by hampering the absorption of nutrients and by slowing down metabolism, thereby making it difficult for food to be broken down into essential nutrients such as fats and carbohydrates. Regular antibiotic medication can cure this disease in the long run, but this can be fatal if left untreated.

Symptoms & Complaints

Since Whipple's disease usually attacks the gastrointestinal system, common symptoms and complaints are diarrhea and stomachache. Abdominal cramps may be experienced after meals.

Malabsorption of nutrients can be evident in unexplained weight loss and weakness. Patients who suffer from Whipple's disease experience agonizing pain. This disease causes irregular bowel movement and dehydration afterward.

Aside from gastrointestinal problems, patients with Whipple's disease also experience other complaints such as inflamed joints, especially wrists, knees, and the ankles.

Patients may also suffer from anemia and fever. Along with fever, cough usually follows. Because Whipple's disease is a bacterial infection, enlarged lymph nodes may be noticeable.

Skin darkening especially in areas that are often exposed to the sun is also a common complaint. If patients have scars, such areas will have unusual darkening, too.

Whipple disease can also affect the central nervous system, causing symptoms and complaints that include memory loss, confusion, visual impairment, and difficulty walking. enlarged spleen and chest pain are additional symptoms. Some of these symptoms may develop slowly. Others are immediately noticeable.

Causes

Tropheryma whipplei is the bacteria which is believed to cause Whipple's disease. This type of bacteria directly affects gastrointestinal areas such as the mucosal lining of the small intestine. It forms lesions in the intestinal walls. It damages the villi in the small intestine.

This infection slowly grows, but it can spread to different parts of the body if not contained or cured immediately. This bacterial infection is rare, and scientists are still studying how it is transmitted and where it originates.

Not all who have this bacterium can develop Whipple's disease. Patients can be found carrying this bacterium without having the corresponding disease. Some scientists think that people with Whipple's disease may have a problem with their immune system that allows this disease to develop when the bacterium happens to be present in the body. Whipple's disease is most common among middle-aged and elderly white males.

Diagnosis & Tests

Doctors will ask the patient about his or her medical history and family history and may conduct a physical examination by identifying the tenderness of abdomen and by discovering skin areas that have unusual darkening.

It is not necessary to experience all the symptoms in order to diagnose Whipple's disease. Doctors may look for them in the course of diagnosis. Another test that can be administered by doctors is a biopsy. This test is done by taking a sample tissue from small intestinal lining. This is possible through upper endoscopy. In this procedure, a thin flexible scope should pass through the mouth, throat, esophagus, stomach, and into the small intestine. The scope will help doctors to view digestive passages and determine where to get sample tissues.

Afterward, several tissue samples are removed from small intestinal areas. The tissues are then examined through a microscope to find out what type of bacteria is causing the disease. If this procedure is not conclusive, doctors may perform a biopsy in the enlarged lymph node.

Blood tests can help identify Whipple's disease. Anemia is one of the common symptoms of this infection, and a blood test may confirm if the anemia is associated with Whipple's disease. A polymerase chain reaction analyzing a stool sample can detect the presence of the bacteria. This test can identify the DNA of the bacteria.

Treatment & Therapy

Whipple's disease is treated with antibiotics. Antibiotics can be taken alone or in combination. Regardless of formulation, antibiotics can destroy such bacteria overtime. It is a long-term treatment which is followed by certain medications that will treat other symptoms. Ceftriaxone and penicillin are two antibiotics that are used to treat Whipple's disease.

Cough is one of the many symptoms of Whipple's disease, but it cannot be cured by the antibiotics for Whipple's disease. Dextromethorphan or salbutamol can be taken depending on the severity of cough. Stomach pain needs fast relief so an antacid medication may temporarily treat the pain.

Nonetheless, a healthier patient may not take long to recover. Doctors will choose an antibiotic that can eliminate not only the infection but also the bacteria that has already spread through the bloodstream toward the brain.

Some bacteria develop antimicrobial resistance over a long period of time. Since the antibiotic medication for Whipple's disease takes long, doctors will monitor whether or not the disease starts developing resistance against the particular antibiotic that is prescribed. Although antibiotics only addresses the infection, symptoms should improve quickly as a result of eliminating the infection.

Prevention & Prophylaxis

Until now, there is no recommended measures to prevent this disease as there is still little information as to how it's transmitted.