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For further information, see CMDT Part 15-32: Protein-Losing Enteropathy

Key Features

  • Any condition causing excessive loss of serum proteins into GI tract

  • Causes include

    • Mucosal disease with ulceration

    • Lymphatic obstruction

    • Idiopathic change in permeability of mucosal capillaries

Clinical Findings

  • Hypoalbuminemia

  • Lymphocytopenia (< 1000/mcL), hypoglobulinemia, hypocholesterolemia in lymphatic obstruction

Diagnosis

  • In most cases, protein-losing enteropathy is secondary to a previously established GI disorder

  • When etiology of GI protein-loss is uncertain, evaluation should be guided by clinical suspicion

  • Exclude nephrotic syndrome, chronic liver disease, heart failure

  • Gut α1-antitrypsin clearance (24-h volume of feces × stool concentration of α1-antitrypsin/serum α1-antitrypsin concentration) of > 27 mL/24 h is diagnostic of a protein-losing enteropathy

  • Obtain lymphocyte count, serum albumin, protein electrophoresis, cholesterol, antinuclear antibody (ANA), and C3 levels

  • Stool samples for ova and parasites

  • Stool qualitative fecal fat determination to look for evidence of malabsorption

  • Small bowel enteroscopy

  • CT enteroscopy or wireless capsule endoscopy of small intestine

  • Colonoscopy

  • CT scan of the abdomen

  • Lymphangiography (rarely needed)

  • Laparotomy with full-thickness intestinal biopsy

Treatment

  • Treat underlying disease

  • Low-fat diets supplemented with medium-chain triglycerides for cases caused by lymphatic obstruction

  • Octreotide may benefit some patients

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