• Davide Scalvini, Patrizia Cambieri, Annalisa Schiepatti, Stiliano Maimaris, Francesca Lusetti, Claudia Vattiato, Piero Marone, Laura Villani, and Federico Biagi.
• Dipartimento di Medicina Interna e Terapia Medica, University of Pavia, Pavia 27100, Italy.
• Eur. J. Intern. Med. 2023 May 1; 111: 778177-81.

IntroductionWhipple's disease is a rare systemic infection due to an impaired immunological response against T. whipplei in genetically predisposed individuals. Since we previously noted development of H. pylori related complications in some patients with Whipple's disease, our aim was to study the prevalence of H. pylori infection and H. pylori related disorders in Whipple's disease.MethodsWhipple's disease patients diagnosed from Jan-2002 to Dec-2021 and two controls per patient, matched for age, gender, ethnicity and year of H. pylori testing were enrolled.Results34 patients with Whipple's disease and 68 controls were enrolled. H. pylori infection (13/34 vs 8/68, p<0.01), H. pylori-related gastritis (p<0.01) and gastric atrophy (p = 0.01) were significantly more common in patients with Whipple's disease than controls. H. pylori infection and Whipple's disease were diagnosed synchronously in 6/13 patients, and during follow-up in the remaining 7. Interestingly, these last 7 patients were all on trimethoprim-sulfamethoxazole long-term therapy. Two patients developed H. pylori-related gastric malignancies during follow-up. No patients on doxycycline developed H. pylori infection.ConclusionsH. pylori infection and related disorders are common in patients with Whipple's disease and should always be excluded both at time of diagnosis and during follow-up. These findings should be taken into account when selecting antibiotics for Whipple's disease long-term prophylaxis.Copyright © 2023 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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