Whipple's disease differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

Whipple's disease must be differentiated from other diseases that cause malabsorption, chronic diarrhea, multisystem involvement, such as celiac disease, cystic fibrosis, inflammatory bowel disease and systemic infections.

Differentiating Whipple's disease from other Diseases

Whipple's disease must be differentiated from other diseases that cause malabsorption, chronic diarrhea, abdominal pain and multisystem involvement.[1][2][3][4][5][6][7][8][9][10][11]

The table below summarizes the diseases that cause malabsorption, diarrhea and abdominal pain.

Abbreviations: WBC: White blood cells; Plt: Platelets, Hgb: Hemoglobin, IgE: Immunoglobulin E, IgA: Immunoglobulin A

Cause Peak age of onset History Physical exam Lab findings Additional findings Cause/Pathogenesis Gold standard diagnosis
Fever Abdominal pain Diarrhea Weight loss
Watery Fatty WBC Hgb Plt Other lab findings
Whipple's disease 40-60 ± + + + + ↓/↑
Celiac disease Childhood

Adult

- + +/- +/- + - -
  • IgA endomysial antibody
  • Anti-tissue transglutaminase antibody
  • Anti-gliadin antibody
  • IgA endomysial antibody
  • IgA tissue transglutaminase antibody
Cystic fibrosis Childhood

Adult

± + - + + - -
  • Positive DNA analysis for CFTR
  • Evaluated nasal transepithelial potential difference (NPD)
Crohns disease Young adults

(20th)

+ + + + +
  • Abnormal immune response to self antigens
Irritable bowel syndrome 30-50 - ± ± ± - - - -
  • Diagnosis of exclusion
VIPoma 30-50 - + + + + - - -
  • Primary secretory tumor
  • Elevated VIP levels
  • Followed by imaging
Zollinger-Ellison syndrome 20-50 - + + + + - -
  • Elevated basal or stimulated serum gastrin> 120 pg/mL
Lactose intolerance Any age - + + - - - - -
Eosinophilic gastroenteritis  30th - + + + + - -
Primary bile acid malabsorption Childhood Adult - + + + + - -
Abetalipoproteinemia Infancy

Adult

- + + + + - - -
Microscopic colitis 50-70 - + + - + - -
Hyperthyroidism Any age ± + + - + - - -
  • Elevated T4
  • Elevated T3
  • Decreased TSH
Grain allergy Childhood - + + - + - - -

References

  1. Hertzler SR, Savaiano DA (1996). "Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance". Am J Clin Nutr. 64 (2): 232–6. PMID 8694025.
  2. Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC (1997). "Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect?". Gut. 41 (5): 632–5. PMC 1891556. PMID 9414969.
  3. BLACK-SCHAFFER B (1949). "The tinctoral demonstration of a glycoprotein in Whipple's disease". Proc Soc Exp Biol Med. 72 (1): 225–7. PMID 15391722.
  4. SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA (1964). "EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME". Gastroenterology. 47: 184–7. PMID 14201408.
  5. Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR; et al. (2005). "Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology". Can J Gastroenterol. 19 Suppl A: 5A–36A. PMID 16151544.
  6. Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D (2002). "Bowel habits and bile acid malabsorption in the months after cholecystectomy". Am J Gastroenterol. 97 (7): 1732–5. doi:10.1111/j.1572-0241.2002.05779.x. PMID 12135027.
  7. Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R; et al. (1991). "Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia". Gastroenterology. 100 (2): 359–69. PMID 1702075.
  8. RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC (1960). "Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue". Gastroenterology. 38: 28–49. PMID 14439871.
  9. Street, Sara; Donoghue, Helen D; Neild, GH (1999). "Tropheryma whippelii DNA in saliva of healthy people". The Lancet. 354 (9185): 1178–1179. doi:10.1016/S0140-6736(99)03065-2. ISSN 0140-6736.
  10. Marth T, Strober W (1996). "Whipple's disease". Semin. Gastrointest. Dis. 7 (1): 41–8. PMID 8903578.
  11. Schneider, Thomas; Moos, Verena; Loddenkemper, Christoph; Marth, Thomas; Fenollar, Florence; Raoult, Didier (2008). "Whipple's disease: new aspects of pathogenesis and treatment". The Lancet Infectious Diseases. 8 (3): 179–190. doi:10.1016/S1473-3099(08)70042-2. ISSN 1473-3099.

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