Current Treatment Options in Gastroenterology

, Volume 2, Issue 5, pp 363–369 | Cite as

Whipple’s disease

  • Nizar N. Ramzan

Opinion statement

The primary aim in treating Whipple’s disease is the eradication of Tropheryma whippelii, a bacillus that infects the small bowel, brain, synovial membranes, heart valves, and many other tissues in patients afflicted with this disease. Antibiotic therapy tends to be prolonged, 1 year or more in duration. If symptoms are primarily gastrointestinal, trimethoprim-sulfamethoxazole is the drug of choice. For patients who are allergic to or intolerant of this medication, a third-generation cephalosporin is used. If presentation also suggests central nervous system involvement, an initial 2-week course of intravenous ceftriaxone, or alternatively a combination of intramuscular benzathine penicillin and streptomycin, should be prescribed prior to a yearlong course with an oral antibiotic. In endocarditis, duration of parental treatment is prolonged to a 6-week course, followed by an oral antibiotic. In rare cases of intolerance to trimethoprim-sulfamethoxazole and cephalosporins, oral combination with tetracycline and rifampicin is reasonable. However, close follow-up and monitoring of T. whippelii eradication should be performed with a polymerase chain reaction (PCR)-based test if tetracycline is used. Knowing whether T. whippelii has been eradicated is also important in a relapse, especially one that involves the central nervous system.
  • Surgery may be performed to remove infected heart valves and joints in rare complicated cases.

  • The role of immunomodulatory treatment is promising but is limited by experience.

  • Nutritional support is a critical part of treatment, especially in patients with diarrhea and weight loss due to malabsorption.


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References and Recommended Reading

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Copyright information

© Current Science Inc 1999

Authors and Affiliations

  • Nizar N. Ramzan
    • 1
  1. 1.Division of Gastroenterology and Hepatology, Department of MedicineMayo Clinic Scottsdale and Mayo Medical SchoolScottsdale

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