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Gastroenterology (Expert Forum)
Whipple`s Disease
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Whipple`s Disease
by LG__0, Apr 25, 1998 12:00AM
Whipples Disease was diagnosed upon PCR reaction in two small
bowl specimens and in liquid from the knee about a year ago.
At this time I had nousea, muscle trembling and maladsorption
and diarrhea. Since then I eat Baktrim forte (1-0-1) per day.
Diarrhea persits since then as I react allergic on the Baktrim(?).
I try to slow down with 1/2 XANAX per day which allows to get
some sleep at night.
Is there a methode to monitore whipple`s disease during Baktrim
treatment?
Is my diarrhea caused by the baktrim or by the primary illness?
Are there alternatives to Baktrim?
Thanks for your help.
Sincerely
L. G.
_Dear L.G.,
Thank you for your recent inquiry about Whipple’s disease. As you know, Whipple’s disease is an uncommon disease which can affect multiple organ systems. Most patients have intestinal malabsorption, weight loss and diarrhea. The disease is caused by a bacteria called Tropheryma whippelii. The diagnosis is established by characteristic findings on small intestinal biopsies and by molecular biological study (PCR) of the involved tissues.
Effective antibiotic therapy for Whipple’s disease is life saving and usually results in prompt and dramatic clinical improvement. Fever and joint symptoms often disappear within a few days and diarrhea and malabsorption usually disappear within 2-4 weeks if not sooner. Many antibiotic regimens have been used successfully in the past. These include: penicillin alone, penicillin plus streptomycin, erythromycin, ampicillin, tetracyclines, chloramphenicol, cephalosporins and trimethoprim/sulfamethoxazole (Bactrim).
Although these antibiotic regimens have been successful, relapses are common and may occur months or years after prolonged administration of antibiotics or while therapy is still in progress. The current therapeutic approach is to start with trimethoprim/sulfamethoxazole (Bactrim). If that does not work then a third generation cephalosporin such as ceftriaxone is recommended. It is recommended that newly diagnosed patients or patients in relapse be treated for 6 to 12 months. Furthermore, an intestinal biopsy should be performed prior to the discontinuation of therapy to make sure that the bacteria is no longer present in the small intestinal lining.
After effective treatment, the lining of the small intestine gradually returns to normal in most patients. . Bacteria disappear from the small intestinal lining after approximately 4-8 weeks. Other residual changes in the small intestinal lining may take years to revert to normal even after successful antibiotic treatment.
The diarrhea that you are currently experiencing can be due to a variety of causes. These include: inadequate treatment for Whipple’s disease, a relapse of Whipple’s disease, antibiotic associated colitis or pseudomembranous colitis (inflammation of the lining of the large intestine) secondary to a bacteria called Clostridium difficile (secondary to Bactrim) or a variety of other causes of diarrhea. I would recommend that you first have a repeat small intestinal biopsy at this time to determine if you were treated adequately with Bactrim. If not you may need alternative treatment. It is best for you to have frequent follow-up office visits with a gastroenterologist to ensure that your treatment is effective. I hope you find this information helpful. Good luck to you. If you are seen at our institution I look forward to meeting you in person.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians’ Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
Keywords: Whipple’s disease, malabsorption, diagnosis, treatment
bowl specimens and in liquid from the knee about a year ago.
At this time I had nousea, muscle trembling and maladsorption
and diarrhea. Since then I eat Baktrim forte (1-0-1) per day.
Diarrhea persits since then as I react allergic on the Baktrim(?).
I try to slow down with 1/2 XANAX per day which allows to get
some sleep at night.
Is there a methode to monitore whipple`s disease during Baktrim
treatment?
Is my diarrhea caused by the baktrim or by the primary illness?
Are there alternatives to Baktrim?
Thanks for your help.
Sincerely
L. G.
_Dear L.G.,
Thank you for your recent inquiry about Whipple’s disease. As you know, Whipple’s disease is an uncommon disease which can affect multiple organ systems. Most patients have intestinal malabsorption, weight loss and diarrhea. The disease is caused by a bacteria called Tropheryma whippelii. The diagnosis is established by characteristic findings on small intestinal biopsies and by molecular biological study (PCR) of the involved tissues.
Effective antibiotic therapy for Whipple’s disease is life saving and usually results in prompt and dramatic clinical improvement. Fever and joint symptoms often disappear within a few days and diarrhea and malabsorption usually disappear within 2-4 weeks if not sooner. Many antibiotic regimens have been used successfully in the past. These include: penicillin alone, penicillin plus streptomycin, erythromycin, ampicillin, tetracyclines, chloramphenicol, cephalosporins and trimethoprim/sulfamethoxazole (Bactrim).
Although these antibiotic regimens have been successful, relapses are common and may occur months or years after prolonged administration of antibiotics or while therapy is still in progress. The current therapeutic approach is to start with trimethoprim/sulfamethoxazole (Bactrim). If that does not work then a third generation cephalosporin such as ceftriaxone is recommended. It is recommended that newly diagnosed patients or patients in relapse be treated for 6 to 12 months. Furthermore, an intestinal biopsy should be performed prior to the discontinuation of therapy to make sure that the bacteria is no longer present in the small intestinal lining.
After effective treatment, the lining of the small intestine gradually returns to normal in most patients. . Bacteria disappear from the small intestinal lining after approximately 4-8 weeks. Other residual changes in the small intestinal lining may take years to revert to normal even after successful antibiotic treatment.
The diarrhea that you are currently experiencing can be due to a variety of causes. These include: inadequate treatment for Whipple’s disease, a relapse of Whipple’s disease, antibiotic associated colitis or pseudomembranous colitis (inflammation of the lining of the large intestine) secondary to a bacteria called Clostridium difficile (secondary to Bactrim) or a variety of other causes of diarrhea. I would recommend that you first have a repeat small intestinal biopsy at this time to determine if you were treated adequately with Bactrim. If not you may need alternative treatment. It is best for you to have frequent follow-up office visits with a gastroenterologist to ensure that your treatment is effective. I hope you find this information helpful. Good luck to you. If you are seen at our institution I look forward to meeting you in person.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians’ Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
Keywords: Whipple’s disease, malabsorption, diagnosis, treatment
Doctor's Answer
