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Role of enteroscopy in the diagnosis of whipple's disease
M Mascarenhas Saraiva1,2, T Ribeiro1,2, T Costa Pereira3
1Department of Gastroenterology, Centro Hospitalar Universitário de São João, Porto, Portugal.
Abstract:
Whipple's disease is a rare chronic systemic infection caused by Tropheryma whipplei. The widespread infection by this rod is responsible for the protean clinical manifestations of the disease, although its classical form is notable for the prevalence of abdominal symptoms such as chronic diarrhea and abdominal pain. Whitish-yellow patches, suggestive of lymphangiectasia, are typically observed in the duodenum during upper endoscopy. The diagnosis of this condition is supported by the identification in duodenal biopsies of Periodic acid-Schiff staining within lamina propria macrophages. Nevertheless, a significant portion of patients do not have lesions within the range of conventional upper endoscopy. Therefore, other endoscopic procedures such as video capsule endoscopy and enteroscopy may be useful to detect more distal lesions. The authors describe a case where the combined used of both techniques allowed the unmasking of this disease.
Insights
Whipple's disease, a rare infection by Tropheryma whipplei, often presents with abdominal issues. Advanced endoscopy techniques like video capsule endoscopy and enteroscopy can help diagnose cases not visible with standard upper endoscopy.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Whipple's disease is a rare, chronic systemic infection caused by the bacterium Tropheryma whipplei.
- Classical Whipple's disease manifests with abdominal symptoms including chronic diarrhea and pain, and duodenal lesions may be observed during upper endoscopy.
Observation:
- Diagnosis is typically confirmed by identifying Periodic acid-Schiff (PAS) staining within duodenal biopsy macrophages.
- However, some patients lack lesions detectable by conventional upper endoscopy, necessitating further investigation.
Findings:
- This case highlights the utility of combining video capsule endoscopy and enteroscopy.
- These advanced endoscopic methods successfully identified distal lesions, aiding in the diagnosis of Whipple's disease.
Implications:
- The findings suggest that advanced endoscopic techniques are crucial for diagnosing Whipple's disease in challenging cases.
- Utilizing video capsule endoscopy and enteroscopy can improve diagnostic yield and patient management for this rare condition.
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