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Protein-Losing Enteropathy

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Essential Medical Disorders of the Stomach and Small Intestine

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Abstract

Protein-losing enteropathy (PLE) refers to a pathologic loss of protein from the gastrointestinal tract. PLE may result from a variety of both intra- and extraintestinal diseases. Patients present with symptomatic hypoalbuminemia leading to peripheral edema, pleural and pericardial effusions, and malnutrition sometimes in the context of symptoms of abdominal pain and diarrhea. PLE should be suspected in patients with low serum albumin after ruling out acute illness, dilutional hypoalbuminemia, renal losses, and synthetic dysfunction. Calculation of fecal alpha-1-antitrypsin clearance is the test of choice for diagnosis. While many treatments have been reported, the cornerstone of therapy centers on treating the underlying cause of the PLE.

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Essential Reading

  1. Levitt DG, Levitt MD. Protein losing enteropathy: comprehensive review of the mechanistic association with clinical and subclinical disease states. Clin Exp Gastroenterol. 2017;10:147–68. https://doi.org/10.2147/CEG.S136803. In-depth review of the pathophysiologic mechanism and diagnosis of PLE.

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  2. Umar SB, DiBaise JK. Protein-losing enteropathy: case illustrations and clinical review. Am J Gastroenterol. 2010;105(1):43–9; quiz 50. https://doi.org/10.1038/ajg.2009.561. Additional case illustrations of causes of PLE with accompanying high yield clinical features.

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Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA, USA

    Brooke Corning & Andrew P. Copland

Authors
  1. Brooke Corning
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  2. Andrew P. Copland
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Corresponding author

Correspondence to Andrew P. Copland .

Editor information

Editors and Affiliations

  1. Mayo Clinic, Jacksonville, FL, USA

    Brian E. Lacy

  2. Mayo Clinic, Scottsdale, AZ, USA

    John K. DiBaise

  3. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Mark Pimentel

  4. Leeds Teaching Hospitals NHS Trust, Leeds Gastroenterology Institute, Leeds, UK

    Alexander C. Ford

Self-Test

Self-Test

  • Question 1: PLE is most commonly described in the literature in what patient population?

    1. A.

      Post-Fontan procedure for congenital heart disease

    2. B.

      Inflammatory bowel disease

    3. C.

      Systemic rheumatologic disorders (e.g., lupus)

    4. D.

      Menetrier’s disease

  • Question 2: A patient is referred for evaluation of symptomatic hypoalbuminemia (albumin 1.9 g/dL) and has an exam notable for peripheral edema and small pleural effusions. They have a history of Crohn’s disease and experience ongoing nonbloody diarrhea. You suspect a diagnosis of protein-losing enteropathy. Which of the following would best confirm this diagnosis?

    1. A.

      A spot stool A1AT of 25 mg/dL

    2. B.

      Stool A1AT clearance of 30 mL/24-hr

    3. C.

      Stool A1AT clearance of 80 mL/24-hr

    4. D.

      Echocardiogram to rule out heart failure and urinalysis to rule out proteinuria.

  • Question 3: Which medical therapy would most benefit the patient with Crohn’s disease described in the previous question after confirmation of PLE?

    1. A.

      Oral furosemide daily

    2. B.

      Initiation of a biologic therapy

    3. C.

      Daily intravenous albumin infusion

    4. D.

      Low-protein diet

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Corning, B., Copland, A.P. (2019). Protein-Losing Enteropathy. In: Lacy, B., DiBaise, J., Pimentel, M., Ford, A. (eds) Essential Medical Disorders of the Stomach and Small Intestine. Springer, Cham. https://doi.org/10.1007/978-3-030-01117-8_19

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  • DOI: https://doi.org/10.1007/978-3-030-01117-8_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-01116-1

  • Online ISBN: 978-3-030-01117-8

  • eBook Packages: MedicineMedicine (R0)

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