title: Tropheryma whippelii DNA is rare in the intestinal mucosa of patients without other evidence of Whipple disease.
abstract: 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.
authors.affiliation: Veterans Affairs Palo Alto Health Care System 154T, 3801 Miranda Avenue, Palo Alto, CA 94304, USA.
authors.forename: M
authors.initials: M
authors.lastname: Maiwald
authors.forename: A
authors.initials: A
authors.lastname: von Herbay
authors.forename: D H
authors.initials: DH
authors.lastname: Persing
authors.forename: P P
authors.initials: PP
authors.lastname: Mitchell
authors.forename: M F
authors.initials: MF
authors.lastname: Abdelmalek
authors.forename: J N
authors.initials: JN
authors.lastname: Thorvilson
authors.forename: D N
authors.initials: DN
authors.lastname: Fredricks
authors.forename: D A
authors.initials: DA
authors.lastname: Relman
mesh_terms: 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*
chemical_list: D004269:DNA, Bacterial