title: [Controversies about the clinical management of Whipple's disease].
abstract: 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.
authors.affiliation: Servicio de Aparato Digestivo, Hospital Ramón y Cajal, Madrid, Spain. elanaoton@terra.es
authors.forename: E
authors.initials: E
authors.lastname: Otón Nieto
authors.forename: A
authors.initials: A
authors.lastname: Cano Ruiz
authors.forename: M A
authors.initials: MA
authors.lastname: Martín Scapa
authors.forename: E
authors.initials: E
authors.lastname: Navas Elorza
authors.forename: N
authors.initials: N
authors.lastname: Camarasa Lillo
authors.forename: A
authors.initials: A
authors.lastname: Palmeiro Uriach
mesh_terms: D000368:Aged; D001706:Biopsy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008061:Whipple Disease / Q000175:diagnosis / Q000188:drug therapy