Background: Little is known about the pathogenesis of Whipple disease, the reservoirs of Tropheryma whippelii, and the proportion of persons harboring the bacterium without "classic" intestinal abnormalities.
Objective: To assess the presence of T. whippelii in patients undergoing upper endoscopy for a variety of indications.
Design: Prospective and routine diagnostic examination of patients.
Setting: Three academic medical centers in California; Minnesota; and Heidelberg, Germany.
Patients: 342 patients undergoing endoscopy for evaluation of dyspepsia or possible peptic ulcer (group A, 173 patients), malabsorption (group B, 37 patients), or clinical suspicion of Whipple disease (group C, 132 patients).
Measurements: Small-intestinal biopsy specimens were tested by polymerase chain reaction for T. whippelii DNA and examined for histopathologic abnormalities.
Results: All patients with negative histologic findings also had negative results for T. whippelii DNA.
Conclusions: T. whippelii occurs only rarely in intestinal mucosa that lacks histopathologic evidence of Whipple disease. The human small intestinal mucosa is an unlikely reservoir for this organism.