When endoscopy became widely available, the diagnosis of Whipple´s disease was reached almost exclusively by histologic analysis of small intestinal biopsies. On this background, a series of 22 consecutive new patients was diagnosed during 1965 and 1983 ( by Herwart F. Otto ) at the Institute of Pathology, University of Hamburg, Germany.

At the time of publication, in 1988, the Hamburg Series was the largest cohort of patients diagnosed by means of endoscopic biopsy and histology. ( 1 ) 

The spectrum of symptoms at the time of endoscopic / histologic diagnosis is summarized below. 

Symptoms of patients* with intestinal Whipple´s disease
                     ( Hamburg Series      1965 - 1983 )

Symptoms                          Patients

Weight Loss                    14  (67%)
Chronic Diarrhea             13  (62%)
Arthralgias/Arthritis      13   (62%)
Abdomial Pain                  11  (52%)
Skin Hyperpigmentation    8  (38%)
Myalgia                              6  (28%)
Lymphadenopathy            3  (14%)
Fever                                 2  (10%)
Abdominal Tumor              1  (  5%)
Sleeping Disorder              1  (  5%)
Cerebral Syncope              1  (  5%)
Gastric Ulcer                      1  (  5%)
Dyspnea                            1  (  5%)

* N = 21 patients.  One autopsy case (from 1965) is not included