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Gastroenterology Research and Practice
Volume 2013 (2013), Article ID 478349, 10 pages
http://dx.doi.org/10.1155/2013/478349
Review Article

Whipple’s Disease: Our Own Experience and Review of the Literature

2nd Department of Medicine-Gastroenterology, Charles University in Praha, Faculty of Medicine at Hradec Králové, University Teaching Hospital, 50005 Hradec Králové, Czech Republic

Received 3 March 2013; Accepted 22 May 2013

Academic Editor: Chris J. J. Mulder

Copyright © 2013 Jan Bureš et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Whipple’s disease is a chronic infectious systemic disease caused by the bacterium Tropheryma whipplei. Nondeforming arthritis is frequently an initial complaint. Gastrointestinal and general symptoms include marked diarrhoea (with serious malabsorption), abdominal pain, prominent weight loss, and low-grade fever. Possible neurologic symptoms (up to 20%) might be associated with worse prognosis. Diagnosis is based on the clinical picture and small intestinal histology revealing foamy macrophages containing periodic-acid-Schiff- (PAS-) positive material. Long-term (up to one year) antibiotic therapy provides a favourable outcome in the vast majority of cases. This paper provides review of the literature and an analysis of our 5 patients recorded within a 20-year period at a tertiary gastroenterology centre. Patients were treated using i.v. penicillin G or amoxicillin-clavulanic acid + i.v. gentamicin for two weeks, followed by p.o. doxycycline (100 mg per day) plus p.o. salazopyrine (3 g per day) for 1 year. Full remission was achieved in all our patients.