Tropheryma whippelii DNA is rare in the intestinal mucosa of patients without other evidence of Whipple disease.
BACKGROUND
Little is known about the pathogenesis of Whipple disease, the reservoirs of Tropheryma whippelii, and the proportion of persons harboring the bacterium without "classic" intestinal abnormalities.


OBJECTIVE
To assess the presence of T. whippelii in patients undergoing upper endoscopy for a variety of indications.


METHODS
Prospective and routine diagnostic examination of patients.


METHODS
Three academic medical centers in California; Minnesota; and Heidelberg, Germany.


METHODS
342 patients undergoing endoscopy for evaluation of dyspepsia or possible peptic ulcer (group A, 173 patients), malabsorption (group B, 37 patients), or clinical suspicion of Whipple disease (group C, 132 patients).


METHODS
Small-intestinal biopsy specimens were tested by polymerase chain reaction for T. whippelii DNA and examined for histopathologic abnormalities.


RESULTS
All patients with negative histologic findings also had negative results for T. whippelii DNA.


CONCLUSIONS
T. whippelii occurs only rarely in intestinal mucosa that lacks histopathologic evidence of Whipple disease. The human small intestinal mucosa is an unlikely reservoir for this organism.
Maiwald
M
M
Veterans Affairs Palo Alto Health Care System 154T, 3801 Miranda Avenue, Palo Alto, CA 94304, USA.
von Herbay
A
A
Persing
D H
DH
Mitchell
P P
PP
Abdelmalek
M F
MF
Thorvilson
J N
JN
Fredricks
D N
DN
Relman
D A
DA
D000192:Actinomycetales / Q000302:isolation & purification*; D000193:Actinomycetales Infections / Q000175:diagnosis / Q000382:microbiology*; D004269:DNA, Bacterial / Q000032:analysis*; D004197:Disease Reservoirs; D004415:Dyspepsia / Q000473:pathology; D004724:Endoscopy; D006801:Humans; D007413:Intestinal Mucosa / Q000382:microbiology* / Q000473:pathology; D007421:Intestine, Small / Q000382:microbiology / Q000473:pathology; D008286:Malabsorption Syndromes / Q000473:pathology; D010437:Peptic Ulcer / Q000473:pathology; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D008061:Whipple Disease / Q000175:diagnosis / Q000382:microbiology*
D004269:DNA, Bacterial