[Controversies about the clinical management of Whipple's disease].
BACKGROUND
There are a lot of controversies related to the diagnostic and therapeutic management of Whipple s disease.


METHODS
We present 4 cases of Whipple's disease, collected from the Gastroenterology Service of the Hospital Ramon y Cajal, from Madrid.


RESULTS
The average age was 69. The first symptoms were in order of frequency, arthralgias, loss of weight, arthritis, diarrhoea, fever, epigastric pain and neurologic symptoms. Three were treated with trimethoprim-sulphamethoxazol and one with cefixime. There were no recurrences.


CONCLUSIONS
The endoscopic appearance of the duodenum is fundamental for the suspicion of the disease. The initial parenteral treatment may consist of ceftriaxone and try to avoid using streptomycine because of its toxicity, followed by oral trimethoprim-sulphamethoxazol. As an alternative to the latter, cefixime is usually effective. The typical findings of the duodenum biopsy can persist several months or years after finishing the treatment, decreasing the value of endoscopic pursuit after treatment.
Otón Nieto
E
E
Servicio de Aparato Digestivo, Hospital Ramón y Cajal, Madrid, Spain. elanaoton@terra.es
Cano Ruiz
A
A
Martín Scapa
M A
MA
Navas Elorza
E
E
Camarasa Lillo
N
N
Palmeiro Uriach
A
A
D000368:Aged; D001706:Biopsy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008061:Whipple Disease / Q000175:diagnosis / Q000188:drug therapy