What Is Protein-Losing Enteropathy?

Protein-loss gastrointestinal diseases are a group of diseases caused by hypoproteinemia caused by the loss of plasma proteins from the gastrointestinal tract caused by various reasons.

Basic Information

English name

protein-losing gastroenteropathy

Visiting department

Internal medicine

Common locations

Gastrointestinal tract

Common causes

Loss of plasma proteins from the gastrointestinal tract due to various reasons

Common symptoms

Lower extremity edema, diarrhea, indigestion, etc.

Causes of protein-loss gastrointestinal disorders

Many gastrointestinal diseases can cause protein loss.

The pathogenesis of protein-loss gastrointestinal disorders is:

1. Gastrointestinal mucosal erosion or ulceration causes protein leakage or leakage;

2. Mucosal cells are damaged or missing, resulting in increased mucosal permeability and leakage of plasma proteins into the intestinal lumen;

3. Intestinal lymphatic obstruction, the protein-rich intestinal stroma cannot be kept in the stroma or absorbed into the blood circulation, overflows into the intestinal cavity and is lost. The mechanism of gastrointestinal disease caused by intestinal inflammation may be due to the exudation of extracellular fluid and inflammatory fluid in the inflammation area.

Clinical manifestations of protein-loss gastroenteropathy

Clinical manifestations vary due to the symptoms and signs of the primary disease.

Lower limb edema

Due to the decrease in plasma colloid osmotic pressure, the leakage of fluid from capillaries is increased, and it can be seen that unilateral edema occurs when the lymphatic vessels are dilated.

2. Indigestion

Due to malabsorption of fats and / or sugars, clinical symptoms of diarrhea and fat-soluble vitamin deficiency may occur.

3. Reduced immune function

Lymphatic obstruction and lymphopenia lead to decreased cellular immune function in patients.

4. Hypoproteinemia

Decrease in plasma albumin, gamma globulin (IgG, IgM, IgA, but often without IgE), human fibrinogen, transferrin, lipoprotein, and serum ceruloplasmin.

Protein loss gastrointestinal examination

Laboratory inspection

(1) ⁵¹ Cr-succinyl chloride This disease relies on measuring the fecal loss of radioactive macromolecules injected intravascularly to determine the diagnosis of protein-loss gastrointestinal disease. Due to radioactive exposure and tedious, expensive and inconvenient, it is not suitable for routine clinical examinations in children.

(2) ₁ -antitrypsin test ₁ -antitrypsin is rarely digested by enterokinase and is mainly excreted from feces in its original form. Can be used as an indirect measurement of albumin lost in the gastrointestinal tract.

2. Other

(1) X-ray examination of the following X-ray signs of the gastrointestinal tract: giant hypertrophy of the gastrointestinal mucosa, X-ray signs of malabsorption, general thickening of the small intestinal mucosa, thickening of the small intestinal mucosa after nodular changes, the above signs Differential diagnosis makes sense. A CT scan of the abdomen can help find mesenteric lymphadenopathy.

(2) Jejunal mucosal biopsy Multiple jejunal mucosal biopsy is meaningful for the diagnosis of lymphoma, celiac disease, eosinophilic gastroenteritis, collagen gastroenteritis, intestinal lymphangiectasis, Whipple disease and so on.

(3) Lymphangiography Congenital or secondary intestinal lymphangiectasis can be identified by foot lymphangiography. The former shows peripheral lymphatic dysplasia and thoracic duct disease. Contrast agent is retained in the retroperitoneal lymph nodes, but the mesenteric lymph system is not full. The latter contrast agent can flow back to the expanded mesenteric lymphatics and overflow to the intestinal or peritoneal cavity.

(4) Examination of ascites Patients with ascites can be used for diagnostic puncture to check ascites cells, proteins, chylomicrons, enzymes, malignant cells, etc.

Diagnosis of protein-loss gastrointestinal disorders

Any unexplained hypoproteinemia with clinical manifestations of gastrointestinal diseases, excluding malnutrition or wasting diseases caused by liver and kidney diseases, should be suspected of this disease.

The diagnosis of this disease should include the following three aspects:

1. There are clinical manifestations of hypoproteinemia as edema and low plasma protein.

2. There is evidence of protein loss from the gastrointestinal tract. Determination of fecal 51Cr albumin and determination of 1 antitrypsin clearance have great significance in diagnosing protein loss from the gastrointestinal tract.

3. Etiological diagnosis can be based on comprehensive analysis and judgment based on medical history, clinical manifestations, and necessary experimental or special examinations.

Differential diagnosis of protein-loss gastrointestinal disorders

This disease should be distinguished from cirrhosis, nephrotic syndrome, hyperthyroidism, malignant tumors, diabetes, congenital hypoalbuminemia and other conditions.

Protein Loss Gastrointestinal Complications

The disease can cause the following complications: reduced plasma albumin, reduced IgG, systemic or local edema caused by water and sodium retention, growth and developmental disorders in children, and death.

Protein Loss Gastroenterology Treatment

This disease should be treated with various effective measures according to different causes. Symptomatic treatment, including low-salt diet, diuretics, etc., intravenous injection of human albumin is effective for a short time.

Cause treatment

Once the cause is identified, appropriate treatment should be given. It should be particularly pointed out that some of the causes of this disease require surgical treatment to be cured, such as malignant tumors, constrictive pericarditis, and huge hypertrophic gastritis. Symptomatic supportive care should only be used when the cause is not yet known or effective treatment is not available for the cause.

2. Symptomatic supportive treatment

(1) Diet A high-protein, high-calorie diet should be given, and a salt-limited diet should be given to those with high edema. For patients with obstructive lymphatic disease, low-fat or medium-chain triacylglycerol (MCT) therapy should be given to reduce intestinal lymphatics. The load of the tube.

(2) Diuretics Potassium-sparing and potassium-releasing diuretics, such as spironolactones and thiazines, can be used in combination , and fast urine diuretics can be used if necessary to reduce edema and reduce ascites.

(3) Correction of hypoalbuminemia As mentioned earlier, intravenous injection of human albumin has only temporary effects. Generally, it is not advisable to correct hypoalbuminemia only by infusion of human albumin, but it is advisable to treat it with the cause and adjust the diet To increase plasma protein concentration.

(4) Symptomatic treatment : Antibiotics should be applied to those who are infected, vitamins should be added to those who are deficient in vitamins, and calcium and magnesium to be added if there is convulsions. Surgical treatment can be used for local resection of localized protein-loss gastrointestinal diseases. If the lymphatic dilatation is limited to a small intestine, a small bowel resection can be performed.