Whipple's disease: Results of long-term follow-up

Aim. To analyze clinical, diagnostic and therapeutic aspects of Whipple's disease. Materials and methods. Diagnostic and therapeutic data ave available for 7 patients registered in 1990-1997 The diagnosis was made using intestinoscope SIF-IOL ("Olympus"). Biopsies were obtained from the jejunal, duodenal and gastric mucosa. The patients received tetracycline, erythromycin, biceptol, on demand - prednisolone. Results. Whipple's disease was diagnosed 6 years on the average following the first clinical symptoms. In most patients the intestinal symptoms were preceded or accompanied by such extraintestinal symptoms as enlargement of the lymph nodes, lowering of hemoglobin, hypoproteinemia, ESR increase to 40-60 mm/h. To study biopsies from the distal duodenum is the only measure needed for diagnosis of Whipple's disease. In untreated patients PAS-positive macrophages are detectable also in gastric body mucosa. The immediate treatment outcome is favorable. The recurrence was observed only in one patient who had given up taking tetracycline. Conclusion. Long-term antibacterial therapy brings the recovery. Primary disorder of the cellular immunity responsible for the disease onset necessitates long-term follow-rep of the patients. Control biopsy should be examined once a year.