Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 15-32: Protein-Losing Enteropathy + Key Features Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ Hypoalbuminemia Lymphocytopenia (< 1000/mcL), hypoglobulinemia, hypocholesterolemia in lymphatic obstruction + Diagnosis Download Section PDF Listen +++ ++ 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 alpha-1-antitrypsin clearance (24-h volume of feces × stool concentration of alpha-1-antitrypsin/serum alpha-1-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 Download Section PDF Listen +++ ++ Treat underlying disease Low-fat diets supplemented with medium-chain triglycerides for cases caused by lymphatic obstruction Octreotide may benefit some patients