Whipple's disease differential diagnosis: Difference between revisions

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'''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>
{| class="wikitable"
!Cause
!History
!Physical exam
!Diagnostic test
!Treatment
|-
|[[lactose intolerance]]
|
* [[Bloating|Bloating,]]
* [[Flatulence]]
* [[Abdominal pain]], and/or [[chronic diarrhea]]
* after ingestion of [[lactose]]
|
* [[Abdominal]] [[tenderness ]]when palpated in severe [[disease]]
* [[Fever]]
* [[Hypotension]]
* [[Tachycardia]]
* [[Nausea and vomiting]]
|[[Hydrogen Breath Test|Lactose breath hydrogen test]]
|Restriction of  [[lactose]] and  maintain [[calcium]] and [[vitamin D]] intake.
|-
|[[Celiac sprue]]
|
* [[Diarrhea]] with bulky, [[Steatorrhea|foul-smelling stools]]
* [[Growth failure]] in children,
* [[Weight loss|Weight loss,]]
* [[Anemia]],
* [[Neurologic diseases|Neurologic disorders]]
* [[Osteopenia]]
|
* [[Neuropsychiatric|Neuropsychiatric disease]]
* [[Dermatitis herpetiformis]]
* [[Arthritis]]
* [[Iron deficiency]]
* [[Metabolic]] bone disease
* [[Hyposplenism]]
* [[Kidney disease]]
* [[Idiopathic pulmonary hemosiderosis]]
|[[Immunoglobulin A]] ([[IgA]]) [[Tissue transglutaminase|anti-tissue transglutaminase]] (TTG) antibody followed by upper [[endoscopy]] with [[biopsy]].
|Dietary counseling, elimination of [[gluten]] in the diet.
|-
|[[Whipple's disease|Whipple disease]]
|
* [[Arthralgias]]
* [[Weight loss]]
* [[Diarrhea]]
* [[Abdominal pain]]
|
* [[Leukocytopenia]]
* [[Thrombocytopenia]]
* [[Skin hyperpigmentation]]
|Upper [[endoscopy]] with [[biopsies]] of the [[small intestine]] for ''[[Tropheryma whipplei|T. whipplei]]'' testing ([[histology]] with [[Periodic acid-Schiff stain|PAS staining]], [[polymerase chain reaction]] testing, and [[immunohistochemistry]])
|[[Doxycycline]] and [[hydroxychloroquine]] are [[bactericidal]]
|}


==References==
==References==

Revision as of 19:18, 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.

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]

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.

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