Whipple's disease: an endoscopic and histologic study.
OBJECTIVE
Primary gastrointestinal tract involvement occurs in one third of patients with Whipple's disease (WD). Nevertheless, there are scant data on the endoscopic appearance of WD. The aim of this study was to provide a detailed endoscopic-pathologic assessment of patients with WD.


METHODS
Four patients with a diagnosis of WD who underwent endoscopic evaluation by a single endoscopist were included. Published information on WD was reviewed in detail, focusing on the endoscopic and histologic features of this disease.


RESULTS
WD had a wide range of endoscopic features, including edema, brown discoloration of the mucosa, erythematous spots, subepithelial hemorrhages, and megaduodenum. Magnification endoscopy revealed engorged and flattened villi, villi filled with white material, and white ring-like structures inside of the villi and multiple yellow spots. The histological features of WD include a coarse granular cytoplasm and foamy macrophages that stain strongly with the period acid-Schiff reagent.


CONCLUSIONS
Gastrointestinal WD has a wide spectrum of endoscopic appearance. Magnification endoscopy enhances the mucosal details. Esophagogastroduodenoscopy with procurement of biopsy specimens from the duodenum was an accurate method for the diagnosis of WD in this case series.
Mönkemüller
Klaus
K
Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University, Magdeburg, Germany. Klaus.Moenkemueller@med.ovgu.de
Fry
Lucia C
LC
von Arnim
Ulrike
U
Neumann
Helmut
H
Evert
Matthias
M
Malfertheiner
Peter
P
D004386:Duodenum / Q000473:pathology; D016145:Endoscopy, Digestive System / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D008061:Whipple Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*