phuluong2k
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45 y/o man with diarrhea for 8 months, lost 15 lbs for the last 8 months, no blood in the stool
24 hour stool collection shows reveal fecal fat of 10 mg/d
D xylose test, less than 2gramx xylose in urine in 5 hours, after treatment of antibiotics, D xylose test have the same result
Most likely diagnosis ?
A. Lactulose intolerance
B. Bacterial overgrowth
C. Pancreatic insufficiency
D. Whipple
E. Terminal ileal disease
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| lucky1
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Whipple's disease- since mucosa is destroyed and therefore D-xylose cant be absorbed.
its not bacterial overgrowth as after course of antibiotic D-xylose is not changed.
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| doc26inder
Forum Elite
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why can't they give other s/s
i also think its whipple's disease ( actually pancreatic insufficiency can also be possible )
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| phuluong2k
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D is the given answer, but how to differentiate whipple from terminal ileal disease
Both of them have reduction of Xylose absorption before & after of antibiotic treatment
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| chemamr
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yeah, in fact i had thought it was E. How did you know it was a Whipple?
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| drkpp
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my knee jerk response will be whipples because have read it as a classical diagnostic finding.
what exactly is this terminal ileal disease?
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| chemamr
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for example in Crohn disease
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| aliakram
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no blood in stool is a clue. Secondly some more info would have been useful. Can any one tell what is the normal amount of fecal fat ?
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| chemamr
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Crohn usually is non bloody diarrhea.
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| chemamr
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>7 g is high
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| aliakram
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thanks ... 
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| maria.b
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well treatment for whipple's is antibiotics too right??TMP-SMX for 6 months-1 year....
so then doesn't that make it terminal ileal disease???
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| Dot
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In terminal ileal disease There will be severe Vit B12 def which is uncommon in whipple .
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| chemamr
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excellent point Dot 
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