Whipple's disease: endoscopic aspects before and after therapy

Area of Science:

• Gastroenterology
• Infectious Diseases
• Pathology

Background:

• Whipple's disease is a rare bacterial infection.
• Diagnosis and monitoring traditionally relied on invasive biopsies.

Purpose of the Study:

• To evaluate the utility and advantages of endoscopy in diagnosing and following Whipple's disease.
• To assess endoscopic findings and their correlation with treatment response and relapse.

Main Methods:

• Retrospective review of 16 Whipple's disease patients diagnosed over 22 years.
• Comparison of diagnostic methods before and after 1980 (peroral suction biopsy vs. upper gastrointestinal endoscopy with small intestinal biopsies).
• Analysis of endoscopic lesion presence, disappearance after treatment, and persistence of histological markers.

Main Results:

• Upper gastrointestinal endoscopy with biopsies diagnosed 11 patients after 1980.
• Gross endoscopic lesions (erosions, yellow plaques, shaggy mucosa) were seen in 9/11 patients and resolved in 5/6 treated patients within 6 months.
• Periodic acid-Schiff-positive macrophages persisted in biopsies long after endoscopic healing.
• Relapses occurred in 5 patients (2-11 years post-treatment), particularly in those treated with tetracycline alone.

Conclusions:

• Endoscopy is a valuable tool for diagnosing Whipple's disease and assessing treatment response.
• Macroscopic lesions suggestive of Whipple's disease can be identified endoscopically.
• Long-term antibiotic therapy is crucial, but relapses necessitate ongoing surveillance due to persistent histological evidence.