Whipple's Disease - Treatment

With the introduction of antibiotic therapy, Whipple's disease has changed from an incurable, rapidly progressive, and fatal condition to a treatable, at least temporarily, condition. Even in severe forms of the disease, marked improvement is observed. Fever and joint symptoms often disappear within a few days of treatment, and diarrhea and malabsorption within 2-4 weeks.

An increase in body weight is noted, followed by a decrease in the size of the tumor, peripheral lymph nodes, and positive dynamics of radiological and endoscopic data.

However, up to now the treatment is carried out empirically. The issue of choosing antibacterial drugs has not been resolved, the optimal course of treatment has not been developed. The main feature is that the treatment should be long-term. In the initial phase (10-14 days) parenteral administration of antibiotics is indicated. A combination of streptomycin (1 g) and penicillin (1,200,000 U) or broad-spectrum antibiotics - tetracycline, ampicillin, etc. are possible.

With improvement of the intestinal absorption condition, long-term oral therapy with tetracycline (1-2 g/day) can be prescribed for up to 5, even 9 months, then intermittent treatment to maintain remission (1 g every other day or 3 days in 1 week with a 4-day break for up to 1-3 years), penicillin-V, etc. Some clinicians believe that antibiotics should be used continuously for 3 years.

The effect of long-term treatment with Biseptol is described. In recent years, many new active antibacterial agents (perfloxacin, intetrix, azitrocycline, etc.) with a wide spectrum of action have appeared, which may prove promising in the treatment of patients with Whipple's disease.

In contrast to the rapid clinical effect, morphological changes in the small intestine usually decrease noticeably only after several months. Whipple's bacilli disappear relatively quickly, while PAS-positive macrophages remain for several months or even years. The reappearance of Whipple's bacilli in the intestinal mucosa months before relapse, and their persistence during antibiotic treatment is a sign of resistance to treatment.

Relapses of the disease often develop after discontinuing antibiotics, even after prolonged administration. Therefore, some recommend lifelong therapy. Antibiotic treatment of recurrent exacerbations of the disease is also effective if another drug is prescribed.

In connection with malabsorption, symptomatic replacement therapy is carried out, aimed at correcting the patient's existing deficiency. Fluid, electrolytes, and protein preparations are administered as indicated. In case of anemia, iron preparations and folic acid are prescribed if necessary. Vitamin D and calcium are recommended at least until diarrhea disappears. In case of tetany, calcium preparations are administered parenterally. In case of diarrhea, astringents and enveloping agents (white clay, calcium carbonate, dermatol, etc.) are used. It may be useful to prescribe smecta, an active adsorbent, a mucous membrane protector. In the development of adrenocortical insufficiency, corticosteroids are indicated.

Since tetracycline antibiotics form poorly soluble complexes with calcium, magnesium, iron and other metal ions, patients who need to eliminate the deficiency of these elements are prescribed other antibiotics.

The diet for Whipple's disease should be high in calories, rich in protein with the addition of therapeutic doses of vitamins, but easily digestible.

Patients are subject to dispensary observation. Along with clinical examination, it is necessary to regularly conduct a repeat biopsy of the small intestine: 2-4 months after the start of treatment, then once a year after the end of chemotherapy.

The prognosis for Whipple's disease used to be absolutely unfavorable. Patients died months to years after diagnosis from exhaustion or infection. Currently, the prognosis is favorable. There are reports of such patients surviving for many years.

Timely recognition of the disease and its relapses is essential for prognosis.