ArticleMedicine2015
Gastrointestinal diagnosis of classical Whipple disease: clinical, endoscopic, and histopathologic features in 191 patients.
Article in Medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 1 of them a synthesis that pooled it.
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Who cites it
38 citing papers in PubMed, 1 synthesis or guideline pooled it, 119 citations in OpenAlex.
- Movement Disorders and Oculomotor Abnormalities in Whipple's Disease: An Updated Systematic Review.Tremor and other hyperkinetic movements (New York, N.Y.) · 2025Pooled it
- Multidisciplinary management of Whipple's disease complicated with rectal stenosis from multidisciplinary nursing management: A case study.Pakistan journal of medical sciences · 2026Article
- Deciphering whipple's disease complexity.Clinical and experimental medicine · 2026Review
- Article
- Whipple Disease Presenting as Isolated Transverse Myelitis with Permanent Neurological Damage in a Patient with Systemic Lupus Erythematosus: A Case Report of a Difficult Diagnosis with a Literature Review.Infectious disease reports · 2024Article
- Lyme disease and Whipple's disease: a comprehensive review for the rheumatologist.Advances in rheumatology (London, England) · 2024Review
- Article
- [Massive pancarditis-autopsy report].Pathologie (Heidelberg, Germany) · 2023Article
- Recovery of hearing loss, depression and erosive polyarthritis after diagnosis of Whipple's disease.Rheumatology advances in practice · 2023Article
- Why Is Whipple's Disease Still a Challenging Diagnosis? A Case Report and Brief Review of Literature.Cureus · 2023Article
- Atypical Whipple's disease with special endoscopic manifestations: A case report.World journal of clinical cases · 2022Article
- Capsule Endoscopy in the Diagnosis, Disease Mapping, and Monitoring of Treatment Response in Gastrointestinal Whipple's Disease.ACG case reports journal · 2022Article
- Challenging case of Whipple's disease: The contribution of radiology.Radiology case reports · 2022Article
- Recurrent thrombosis as a clinical presentation of Whipple disease.BMJ case reports · 2022Article
- Whipple's disease: a case report in Santa Catarina, Brazil.Le infezioni in medicina · 2022Article
- Cutaneous Granulomatosis Revealing Whipple's Disease: Value ofPathogens (Basel, Switzerland) · 2021Article
- [A 3-week history of intestinal symptoms in a 67-year-old male patient with chronic arthralgia].Der Internist · 2021Article
- Whipple's disease: the great masquerader-a high level of suspicion is the key to diagnosis.BMC gastroenterology · 2021Article
- Differential diagnostic value of rheumatic symptoms in patients with Whipple's disease.Scientific reports · 2021Article
- Article
Corrections and comments
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Authors and funding
8 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Classic Whipple disease (CWD) is a systemic infection caused by Tropheryma whipplei. Different diagnostic tools have been developed over the last decades: periodic acid-Schiff (PAS) staining, T whipplei-specific polymerase chain reaction (PCR), and T whipplei-specific immunohistochemistry (IHC). Despite all these advances, CWD is still difficult to diagnose because of a variety of clinical symptoms and possibly a long time span between first unspecific symptoms and the full-blown clinical picture of the disease. Herein, we report an observational cohort study summarizing epidemiologic data, clinical manifestations, and diagnostic parameters of 191 patients with CWD collected at our institution. Gastrointestinal manifestations are the most characteristic symptoms of CWD affecting 76% of the cohort. Although the small bowel was macroscopically conspicuous in only 27% of cases, 173 (91%) patients presented with characteristic histological changes in small bowel biopsies (in 2 patients, these changes were only seen within the ileum). However, 18 patients displayed normal small bowel histology without typical PAS staining. In 9 of these patients, alternative test were positive from their duodenal specimens (ie, T whipplei-specific PCR and/or IHC). Thus, in 182 patients (95%) a diagnostic hint toward CWD was obtained from small bowel biopsies. Only 9 patients (5%) were diagnosed solely based on positive T whipplei-specific PCR and/or IHC of extraintestinal fluids (eg, cerebrospinal fluid, synovial fluid) or extraintestinal tissue (eg, lymph node, synovial tissue), respectively. Thus, despite efforts to diagnose CWD from alternative specimens, gastroscopy with duodenal biopsy and subsequent histological and molecular-biological examination is the most reliable diagnostic tool for CWD.
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