What is Protein-Losing Enteropathy?
Protein losing enteropathy is a medical condition involving the gastrointestinal tract, which causes loss of plasma protein into the intestine. There are different causes for Protein Losing Enteropathy, such as acute intestinal ulceration, gluten enteropathy, intestinal lymphatic blockage and infiltration of leukemic cells into the intestinal wall
Pathophysiology of Protein-Losing Enteropathy
Loss of plasma proteins leads to protein losing enteropathy, which then enters the lumen of the gastrointestinal tract. Protein losing enteropathy can also occur as a result of a complication of some disorder or from a mucosal injury or lymphatic obstruction.
In cases of pediatric protein losing enteropathy the epithelial cells have many changes in them resulting in protein losing enteropathy and it also increases the rate of protein flow. Dysfunctional lymphatic drainage or congenital molecular abnormalities can cause changes in the epithelial matrix. Proteoglycans can also directly cause protein losing enteropathy along with an increase in the inflammatory cytokines. Protein losing enteropathy is also usually found in children suffering from congenital glycosylation defects.
Causes of Protein-Losing Enteropathy
There are different causes of protein-losing enteropathy, which include gastrointestinal conditions, among other causes, including: Idiopathic ulcerative jejunoileitis, inflammatory bowel disease, neoplasm (secondary obstruction), infection (secondary obstruction), sarcoidosis (secondary obstruction), systemic lupus erythematosus (SLE), amyloidosis, Ménétrier’s disease, Zollinger-Ellison syndrome, celiac disease, eosinophilic gastroenteritis, primary intestinal lymphangiectasia and Common Variable Immunodeficiency (CVID).
Signs & Symptoms of Protein-Losing Enteropathy
Common causes of protein losing enteropathy consist of fever, general abdominal discomfort and diarrhea. Patient can also have swelling in the legs due to peripheral edema. If systemic diseases, such as constrictive pericarditis or congestive heart failure, are causing protein losing enteropathy then symptoms could be indicative of development of the primary disease.
Diagnosis of Protein-Losing Enteropathy
The diagnosis of protein losing enteropathy can be confirmed after other causes of protein loss are eliminated or ruled out. Endoscopy can be done to pinpoint the cause of the protein loss in the bowel. Fecal excretion of alpha 1-antitrypsin and viral serologies are also helpful in detecting protein losing enteropathy.
How is Protein-Losing Enteropathy Treated?
- Treatment depends on the underlying cause of protein losing enteropathy. Treatment of hypoproteinemia should be done accordingly.
- If protein losing enteropathy occurs after a Fontan operation, then treatment should be done according to the level of hypoproteinemia in the patient. So, patients should be categorized according to their serum albumin levels.
- Aldactone and furosemide can be given to patients with mild hypoproteinemia and who have edema or swelling in the legs for relief.