Whipple's disease differential diagnosis: Difference between revisions
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{{CMG}}; {{AE}} {{SSH}} | |||
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==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]. | |||
==Differentiating Whipple's disease from other Diseases== | ==Differentiating Whipple's disease from other Diseases== | ||
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*[[Addison's disease]] | *[[Addison's disease]] | ||
The following diseases have presentations similar to that of Whipple's disease. | The following diseases have presentations similar to that of Whipple's disease. | ||
'''The table below summarizes the findings that differentiate fatty causes of [[chronic diarrhea]]'''<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> | '''The table below summarizes the findings that differentiate fatty causes of [[chronic diarrhea]]'''<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> | ||
Revision as of 15:40, 27 October 2017
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.
- Malabsorption with small intestine involvement (celiac disease, sarcoidosis, and lymphoma)
- Infections such as tuberculosis, endemic fungi (eg, Histoplasma spp), Rhodococcus and HIV infection
- Inflammatory bowel diseases
- 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 findings that differentiate fatty causes of chronic diarrhea[1][2][3]
| Cause | History | Physical exam | Diagnostic test | Treatment |
|---|---|---|---|---|
| lactose intolerance |
|
|
Lactose breath hydrogen test | Restriction of lactose and maintain calcium and vitamin D intake. |
| Celiac sprue |
|
Immunoglobulin A (IgA) anti-tissue transglutaminase (TTG) antibody followed by upper endoscopy with biopsy. | Dietary counseling, elimination of gluten in the diet. | |
| Whipple disease | Upper endoscopy with biopsies of the small intestine for T. whipplei testing (histology with PAS staining, polymerase chain reaction testing, and immunohistochemistry) | Doxycycline and hydroxychloroquine are bactericidal |
References
- ↑ 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.
- ↑ 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.
- ↑ 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.