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Whipple's Disease - Symptoms, Causes, Diagnosis, and Treatment

Published on Dec 02, 2022 and last reviewed on Jan 19, 2023   -  4 min read


Whipple's disease is a bacterial infection affecting the joints and the digestive system. Read the article to learn more about Whipple's disease.


Whipple's disease is a rare infection that is caused by the bacterium tropheryma whipplei belonging to the family actinomycetes commonly found in the soil. It is a systemic infection. The disease is common in farmers and those exposed to soil and animals. George Hoyt Whipple first described the disease in 1907. This disease most commonly affects the joints and the digestive system. It mainly affects the small intestine. Whipple's disease interferes with normal absorption. Whipple's disease is a multisystem disease affecting other organs, including the brain, heart, lungs, and eyes. The disease can be fatal if untreated. Whipple's disease is highly uncommon, affecting one in one million people. They are also known as intestinal lipodystrophy.

What Are the Symptoms of Whipple's Disease?

Symptoms mostly start slowly. Joint pain is a common early symptom, and gastrointestinal problems occur later. Signs of the disease vary from one person to another. Whipple's disease is not contagious.

The most common symptoms include:

  • Diarrhea.

  • Abdominal pain and cramps.

  • Pain and stiffness in joints, particularly in ankles, knees, and fingers.

  • Weight loss due to malabsorption of nutrients.

  • Chronic malabsorption leads to steatorrhea (fatty foul-smelling stool).

  • Bloody stools.

Other symptoms associated with Whipple's disease include:

Some less common signs and symptoms of Whipple's disease include:

  • Fever and chills.

  • Cough.

  • Chest pain.

  • Lymph node enlargement.

  • Darkening of skin in sun-exposed areas.

  • Decrease in blood protein - albumin.

  • Endocarditis (infection of the heart valve).

Neurological signs and symptoms include:

  • Confusion.

  • Memory loss.

  • Seizures.

  • Poor coordination.

  • Dementia.

  • Difficulty in walking.

  • Vision problems.

What Causes Whipple's Disease?

Whipple's disease is a bacterial infection caused by tropheryma whipplei. The bacteria first affects the mucosal lining of the small intestine, forming ulcers in the small intestine wall. The bacteria also damages villi, which are tiny finger-like projections lining the small intestine.

What Are the Risk Factors of Whipple's Disease?

Risk factors of Whipple's disease are not identified. Some factors include:

  • Men of age 40-60.

  • People who work outdoors and have contact with sewage and wastewater.

  • Whites living in North America and Europe.

How Is It Classified?

Based on organ involvement, Whipple's disease is divided into three forms:

  • Classic Whipple's disease.

  • Isolated neurological Whipple's disease.

  • Endocarditis associated with Whipple's disease.

How Can We Diagnose Whipple's Disease?

  • Physical Examination: The doctor will check for signs and symptoms of the disease. The doctor will look for stomach tenderness, skin darkening in sun-exposed areas, enlarged lymph nodes, and heart murmur.

  • Biopsy: The doctor will do an endoscopy procedure. A thin, flexible tube called an endoscope is attached with a light and a camera and is inserted through the mouth to the stomach and small intestine. The endoscope helps in viewing the inside of the stomach. The doctor takes a tissue sample (biopsy) from the small intestine lining during the procedure. This tissue sample is examined under a microscope for the presence of the disease-causing bacteria tropheryma whipplei.

  • Blood Test: Complete blood count is taken to rule out anemia associated with the disease.

  • Stool Test: A stool test is done if diarrhea is present.

  • Polymerase Chain Reaction: It is a highly sensitive test that finds out the deoxyribonucleic acid (DNA) of the bacteria from the tissue samples. This test confirms the presence of tropheryma whipplei bacteria in the tissue.

What Is the Treatment of Whipple's Disease?

Since it is a bacterial infection, the treatment is usually done with antibiotics alone or in combination. Treatment is long-term, which takes a year, or longer but symptomatic relief is often seen in the first week. People with no brain or nervous system complications recover completely after a full course of antibiotics.

The doctor selects antibiotics that can clear infections in the small intestine lining and also cross the brain barrier to treat the bacteria that have entered the brain. Since antibiotics are used for a more extended period, antibiotic resistance should be monitored.

Initial therapy of Whipple's disease begins with two to four weeks of Ceftriaxone or Penicillin given through the vein. Following this, an oral course of Sulfamethoxazole -Trimethoprim is taken for one to two years. Alternative medications include oral Doxycycline combined with anti-malarial drug Hydroxychloroquine for one to two years.

Side effects of Ceftriaxone and Sulfamethoxazole-Trimethoprim include nausea, vomiting, diarrhea, and allergic reactions. Side effects of Doxycycline include nausea, vomiting, loss of appetite, and sensitivity to sunlight. Side effects of Hydroxychloroquine include diarrhea, stomach cramps, diarrhea, loss of appetite, and dizziness.

Some patients get relapse into the disease with worsening neurological symptoms. They are treated with antibiotics and Interferon-gamma injection, a protein that activates the immune system.

Vitamin and nutrient supplements are recommended due to malabsorption. Vitamin D, iron, calcium, folic acid, and magnesium are recommended. A diet rich in proteins and calories is recommended to compensate for the malnutrition of Whipple disease. Fluid replacement is given to prevent dehydration.

How Can We Prevent Whipple's Disease?

As of now, there is no preventive measure for Whipple's disease. Practicing good hygiene like washing hands regularly and wearing gloves while working in the soil can reduce the risk of Whipple's disease.

What Are the Complications?

  • Brain damage.

  • Heart valve damage.

  • Inflammation of the pericardium - pericarditis.

  • Inflammation of the inner lining of the heart- endocarditis.

  • Weight loss.

  • Nutritional deficiencies.

What Is the Prognosis?

With early diagnosis and proper treatment, the prognosis of Whipple's disease is good. Relapse is common in Whipple's disease. So, the patients should be closely monitored and undergo endoscopy with biopsy and other tests a year after the treatment. If untreated, Whipple's disease will get worse and is often fatal.


Whipple's disease is a rare condition but can be life-threatening. Continuing antibiotics for up to one year can treat the disease, and relapses are common. Usually, many symptoms go away in a month once the treatment begins.


Frequently Asked Questions


Is Whipple’s Disease a Hereditary Condition?

 Whipple disease is caused by a type of bacteria, Tropheryma Whipple. But some researchers believe that genetic defects in the immune system play a role in developing the condition, and people are more likely to become sick when exposed to bacteria.


Is Whipple’s Disease Contagious?

Bacteria cause Whipple disease. However, the exact exposure of the bacteria on the body is unknown. There is no evidence that the disease is contagious. Whipple disease is not passed from person to person.


Is Whipple’s Disease Common?

Whipple disease is an extremely uncommon condition. It is caused due to bacteria that affect the genetically modified immune system. It rarely occurs. One in one million cases has been recorded so far.


How to Check for Whipple’s Disease?

Along with normal signs and symptoms, such as pain, diarrhea, stomach cramps, weight loss, and malabsorption. A Whipple test is conducted to check for the disease. This test examines partial rotator cuff tears and superior labrum tears. And biopsy specimens are taken to detect bacteria affecting by the DNA.


Who Is More Prone to Whipple’s Disease?

Men are more prone to Whipple disease than women. Especially people from Europe and North America get affected. Individuals who work outdoors and have frequent contact with wastewater and sewage and farmers are more prone to Whipple disease


Can Alcohol Be Consumed After a Whipple’s Disease?

Consuming alcohol can result in leading the condition fatal. It can be one of the risk factors that can worsen the condition. Thus, avoiding the consumption of alcohol during Whipple disease can be beneficial.


Can Whipple’s Lead to Iron Deficiency?

Individuals affected by Whipple disease fail to absorb enough nutrients from the food consumed, as the bacteria impairs the food breakdown and hampers the body’s ability to absorb nutrients, thus failing to absorb enough iron and minerals as well, which can lead to iron deficiency.


Why Is the Gallbladder Removed During Whipple’s Surgery?

As a part of Whipple surgery, the gall bladder is removed. Whipple disease affects the organs. It is an optional procedure where the pancreas, bile duct, or duodenum is affected by cancer or other disorders.


Can Normal Life Be Led After Whipple Surgery?

Individuals leave the hospital within a week after the surgery. In most cases, it takes around two to six months to recover fully and return to normal life. Yes, normal life can be led after the Whipple surgery.


Do People Lose Weight After Whipple?

Yes, people do lose weight after Whipple. In many cases, losing up to 5 to 10 % of an individual's body weight is normal after undergoing a Whipple procedure.


Does Whipple Disease Lead To Constipation?

The Whipple disease is characterized by intense abdominal pain, nausea, bleeding, and constipation. This condition impairs the digestion and breakdown of food and fails to absorb nutrients. It leads to many deficiencies and constipation due to undigested food.


In Which Part Is Whipple Disease Most Common?

Whipple disease can affect many organs, including the heart, eyes, and brain, but it mostly affects the digestive tract and joints. It impairs digestion and impairs body’s capacity to absorb nutrients, and without treatment, it can become fatal.


How Does Whipple’s Disease Affect the Brain?

Whipple disease occurs at many sites; consequent symptoms of the brain being affected can be detected by cortical blindness, seizures, cranial nerve disturbances, dysphasia, trigeminal neuralgia, cerebellar signs, and brainstem signs. Whipple disease can also affect the eye.


How to Eat After Whipple Surgery?

Eat meals in smaller portions. To get healed soon, eat foods high in protein, poultry, fish, eggs, peanut butter, and beans. Drink liquid supplements can be taken. Initially, there might be a disturbance in tolerating fatty foods.

Article Resources

Last reviewed at:
19 Jan 2023  -  4 min read




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