Whipple's disease: treatment

With the introduction of antibiotic therapy, Whipple's disease of the incurable with a rapidly progressing course and lethal outcome has become cured, at least temporarily, by suffering. Even with severe forms of the disease, there is a marked improvement. Fever and joint symptoms often disappear within a few days after the start of treatment, and diarrhea and malabsorption - after 2-4 weeks.

There is an increase in body weight, followed by a decrease in the size of the tumor, peripheral lymph nodes, positive dynamics of X-ray and endoscopic data.

However, until now, 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 - treatment should be long. In the initial phase (10-14 days), parenteral administration of antibiotics is indicated. Combination of streptomycin (1 g) and penicillin (1 200 000 units) or antibiotics of a wide spectrum of action - tetracycline, ampicillin and others are possible.

If the condition of intestinal absorption is improved, prolonged oral tetracycline therapy (1-2 g / day) can be administered up to 5, even 9 months, then intermittent treatment to maintain remission (1 g at 1 day or 3 days at 1 week with a 4-day break before 1-3 years), penicillin-V, etc. Some clinicians believe that antibiotics should be used continuously for 3 years.

The effect of prolonged treatment with biseptol is described. In recent years, many new active antibacterial agents have appeared (perfloxacin, intetriks, azithrocycline, etc.) with a wide spectrum of action that 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, as a rule, noticeably decrease only after a few months. "Whipple bacilli" disappear relatively soon, while PAS-positive macrophages remain for several months and even years. The reappearance of "Whipple bacilli" in the intestinal mucosa precedes the relapse in months, and their retention in the treatment with antibiotics is a sign of resistance to treatment.

Relapses of the disease develop often after the abolition of antibiotics, even after prolonged administration. Therefore, some recommend lifelong therapy. Treatment with antibiotics relapse is also effective if another drug is prescribed.

In connection with malabsorption, symptomatic substitution therapy is performed, aimed at correcting the deficit in the patient. The indications are fluid, electrolytes, protein preparations. When anemia, if necessary, prescribe iron preparations, folic acid. Vitamin D and calcium are recommended at least until the disappearance of diarrhea. In tetany, calcium preparations are injected parenterally. With diarrhea, astringent, enveloping agents (white clay, calcium carbonate, dermatol, etc.) are used. It may be useful to appoint a smectite, an active adsorbent, a tread of the mucous membrane. With the development of adrenocortical insufficiency, corticosteroids are shown.

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

Diet in Whipple's disease should be high-calorie, rich in protein with the addition of therapeutic doses of vitamins, but easily digestible.

Patients are subject to follow-up. In addition to the clinical examination, a regular biopsy of the small intestine should be performed regularly: 2-4 months after the start of treatment, then once a year after the end of chemotherapy.

The prognosis for Whipple's disease was previously absolutely unfavorable. Patients died a few months after the diagnosis was established from exhaustion or from infection. Currently, the outlook is favorable. It is reported about the life of such patients for many years.

For the prediction, a timely recognition of the disease and its relapse is essential.