Tropheryma whippelii DNA is rare in the intestinal mucosa of patients without other evidence of Whipple disease

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 up per endoscopy for a variety of indications. Design: Prospective and routine diagnostic examination of patients. Setting: Three academic medical centers in California; Minnesota; and Heide lberg, Germany. Patients: 342 patients undergoing endoscopy for evaluation of dyspepsia or possible peptic ulcer (group A, 173 patients), malabsorption (group B, 37 p atients), or clinical suspicion of Whipple disease (group C, 132 patients). Measurements: Small-intestinal biopsy specimens were tested by polymerase c hain reaction for T. whippelii DNA and examined for histopathologic abnorma lities. Results: All patients with negative histologic findings also had negative r esults for T. whippelii DNA. Conclusions: T. whippelii occurs only rarely in intestinal mucosa that lack s histopathologic evidence of Whipple disease. The human small intestinal m ucosa is an unlikely reservoir for this organism.