Whipple's Disease, Intestinal Pseudo-Obstruction

Whipple's Disease
Whipple's disease is a rare infectious disease that typically infects the bowel. It causes malabsorption primarily but may affect any part of the body including the heart, lungs, brain, joints, and eyes. It interferes with the body's ability to absorb certain nutrients. Whipple's disease causes weight loss, incomplete breakdown of carbohydrates or fats, and malfunctions of the immune system. When recognized and treated, Whipple's disease can usually be cured. Untreated, the disease may be fatal.

Whipple's disease is caused by bacteria named Tropheryma whippelii. It can affect any system of the body, but occurs most often in the small intestine. Lesions appear on the wall of the small intestine and thicken the tissue. The villi—tiny, finger-like protrusions from the wall that help absorb nutrients—are damaged.

Symptoms include diarrhea, intestinal bleeding, abdominal pain, loss of appetite, weight loss, fatigue, and weakness. Arthritis and fever often occur several years before intestinal symptoms develop. Patients may experience neurological symptoms as well. Diagnosis is based on symptoms and the results of a biopsy of tissue from the small intestine or other organs that are affected.

Whipple's disease is treated with antibiotics to destroy the bacteria that cause the disease. The physician may use a number of different types, doses, and schedules of antibiotics to find the best treatment. Depending on the seriousness of the disease, treatment may also include fluid and electrolyte replacement. Electrolytes are salts and other substances in body fluid that the heart and brain need to function properly. Extra iron, folate, vitamin D, calcium, and magnesium may also be given to help compensate for the vitamins and minerals the body cannot absorb on its own.

Full recovery of the small intestine may take up to 2 years, but the symptoms usually disappear in less time. Because relapse is common even after successful treatment, the health care team may continue to monitor the patient for many years.

Intestinal Pseudo-Obstruction
Intestinal pseudo-obstruction (false blockage) is a condition that causes symptoms like those of a bowel obstruction (blockage). But when the intestines are examined, no obstruction is found. A problem in how the muscles and nerves in the intestines work causes the symptoms.

Pseudo-obstruction symptoms include cramps, stomach pain, nausea, vomiting, bloating, fewer bowel movements than usual, and loose stools. Over time, pseudo-obstruction can cause bacterial infections, malnutrition, and muscle problems in other parts of the body. Some people also have bladder problems.

Diseases that affect muscles and nerves, such as lupus erythematosus, scleroderma, or Parkinson's disease, can cause symptoms. When a disease causes the symptoms, the condition is called secondary intestinal pseudo-obstruction. Medications that affect muscles and nerves such as opiates and antidepressants might also cause secondary pseudo-obstruction.

To diagnose the condition, the doctor will take a complete medical history, do a physical exam, and take x rays. The usual treatments are nutritional support (intravenous feeding) to prevent malnutrition and antibiotics to treat bacterial infections. Medication might also be given to treat intestinal muscle problems. In severe cases, surgery to remove part of the intestine might be necessary.