Enteropathy, Protein-Losing

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

Hypoalbuminemia

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

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

Treat underlying disease

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

Octreotide may benefit some patients