eMedicine Specialties > Gastroenterology > Intestine

Whipple Disease: Follow-up

Author: Ingram M Roberts, MD, MBA, Associate Clinical Professor of Medicine, University of Connecticut School of Medicine; Program Director of Internal Medicine Residency, Vice Chairman, Department of Medicine, St Vincent's Medical Center
Contributor Information and Disclosures

Updated: Aug 14, 2008

Follow-up

Further Inpatient Care

  • Once the diagnosis of Whipple disease is established and antibiotics are started, patients may be discharged for continued therapy as outpatients.

Further Outpatient Care

  • Patients with clinical Whipple disease should be monitored with a PCR test because it is the most sensitive and specific (in contrast to histology) method to determine if they are responding to antibiotic therapy.
  • T whippelii has been detected through PCR in normal saliva, gastric juice, and intestinal tissue. Whether its presence in otherwise healthy patients reflects a pathological state is unclear. Host factors may be important (as in the case of other GI conditions, such as H pylori infection) in determining which patients will actually develop clinical manifestations.

Complications

  • Reactions or allergies to antibiotics may occur that could require changing the antibiotic agent.

Prognosis

  • If Whipple disease is untreated, the prognosis is poor, and mortality approaches 100% after 1 year.
  • If treated for a full year, the prognosis usually is good. Clinical remission occurs in approximately 70% of patients.
  • Up to 30-40% of patients may relapse, and relapse appears to be more common in patients with CNS Whipple disease.

Patient Education

  • No special advice is required.

Miscellaneous

Medicolegal Pitfalls

  • Failure to carefully explain that patients must comply with follow-up care
 


More on Whipple Disease

Overview: Whipple Disease
Differential Diagnoses & Workup: Whipple Disease
Treatment & Medication: Whipple Disease
Follow-up: Whipple Disease
References
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References

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  2. Raoult D, Birg ML, La Scola B, et al. Cultivation of the bacillus of Whipple's disease. N Engl J Med. Mar 2 2000;342(9):620-5. [Medline].

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  4. Patel SJ, Huard RC, Keller C, et al. Possible Case of CNS Whipple's Disease in an Adolescent With AIDS. J Int Assoc Physicians AIDS Care (Chic Ill). Jun 2008;7(2):69-73. [Medline].

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  16. Keinath RD, Merrell DE, Vlietstra R, et al. Antibiotic treatment and relapse in Whipple's disease. Long-term follow-up of 88 patients. Gastroenterology. Jun 1985;88(6):1867-73. [Medline].

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Further Reading

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Keywords

Whipple disease, Whipple's disease, Tropheryma whippelii, T whippelii, intestinal lipodystrophy, WD, polyarthralgias, chronic diarrhea, Whipple disease with symptomatic CNS involvement, fever of unknown origin

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Contributor Information and Disclosures

Author

Ingram M Roberts, MD, MBA, Associate Clinical Professor of Medicine, University of Connecticut School of Medicine; Program Director of Internal Medicine Residency, Vice Chairman, Department of Medicine, St Vincent's Medical Center
Ingram M Roberts, MD, MBA is a member of the following medical societies: American College of Gastroenterology, American College of Physician Executives, American College of Physicians, American Gastroenterological Association, American Medical Informatics Association, American Society for Gastrointestinal Endoscopy, and Association of Program Directors in Internal Medicine
Disclosure: Nothing to disclose.

Medical Editor

Marco G Patti, MD, Professor of Surgery, Director, Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine
Marco G Patti, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Surgical Association, Association for Academic Surgery, Pan-Pacific Surgical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Southwestern Surgical Congress, and Western Surgical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Noel Williams, MD, Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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