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Protein-Losing Enteropathy Differential Diagnoses

  • Author: Naeem Aslam, MD; Chief Editor: Julian Katz, MD  more...
 
Updated: Dec 29, 2015
 
 

Diagnostic Considerations

Clinicians should have a high index of suspicion for protein-losing enteropathy as an uncommon complication of inflammatory bowel disease, particularly in the setting of hypoproteinemia without concomitant hepatic disease, severe malnutrition, or proteinuria.[21]  

The following conditions should also be considered in patients with suspected protein-losing enteropathy:

  • Cutaneous burns
  • Parasitic infections
  • Viral enteritis

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Naeem Aslam, MD Fellow, Department of Medicine, Division of Gastroenterology/Hepatology, University of Louisville School of Medicine

Naeem Aslam, MD is a member of the following medical societies: American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Coauthor(s)

Richard Wright, MD Professor and Chief, Department of Medicine, Division of Gastroenterology/Hepatology, University of Louisville School of Medicine

Richard Wright, MD is a member of the following medical societies: American Association for Physician Leadership, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Noel Williams, MD, FRCPC FACP, MACG, Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada

Noel Williams, MD, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Terence David Lewis, MBBS, MBBS 

Terence David Lewis, MBBS, MBBS is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, California Medical Association, Royal College of Physicians and Surgeons of Canada, Sigma Xi

Disclosure: Nothing to disclose.

References
  1. Lee YT, Sung JJ. Protein-losing enteropathy. Gastrointest Endosc. 2004 Nov. 60(5):801-2. [Medline].

  2. Laine L, Garcia F, McGilligan K, et al. Protein-losing enteropathy and hypoalbuminemia in AIDS. AIDS. 1993 Jun. 7(6):837-40. [Medline].

  3. Waldmann TA, Wochner RD, Strober W. The role of the gastrointestinal tract in plasma protein metabolism. Studies with 51Cr-albumin. Am J Med. 1969 Feb. 46(2):275-85. [Medline].

  4. Rybolt AH, Bennett RG, Laughon BE, et al. Protein-losing enteropathy associated with Clostridium difficile infection. Lancet. 1989 Jun 17. 1(8651):1353-5. [Medline].

  5. Akgün A, Tani Acar E, Taner MS, et al. Scintigraphic diagnosis of protein-losing enteropathy secondary to amyloidosis. Turk J Gastroenterol. 2005 Mar. 16(1):41-3. [Medline].

  6. Cheong JL, Cowan FM, Modi N. Gastrointestinal manifestations of postnatal cytomegalovirus infection in infants admitted to a neonatal intensive care unit over a five year period. Arch Dis Child Fetal Neonatal Ed. 2004 Jul. 89(4):F367-9. [Medline].

  7. Pratz KW, Dingli D, Smyrk TC, et al. Intestinal lymphangiectasia with protein-losing enteropathy in Waldenstrom macroglobulinemia. Medicine (Baltimore). 2007 Jul. 86(4):210-4. [Medline].

  8. Venkatesh B, Gough J, Ralston DR, et al. Protein losing enteropathy in critically ill adult patients with burns: a preliminary report. Intensive Care Med. 2004 Jan. 30(1):162-6. [Medline].

  9. Citrin Y, Sterling K, Halsted JA. The mechanism of hypoproteinemia associated with giant hypertrophy of the gastric mucosa. N Engl J Med. 1957 Nov 7. 257(19):906-12. [Medline].

  10. Overholt BF, Jeffries GH. Hypertrophic, hypersecretory protein-losing gastropathy. Gastroenterology. 1970 Jan. 58(1):80-7. [Medline].

  11. Fretzayas A, Moustaki M, Alexopoulou E, Nicolaidou P. Menetrier's disease associated with Helicobacter pylori: three cases with sonographic findings and a literature review. Ann Trop Paediatr. 2011. 31(2):141-7. [Medline].

  12. Ito R, Sakagami J, Kataoka K, et al. Chronic diarrhea and protein-losing gastroenteropathy caused by Dientamoeba fragilis. J Gastroenterol. 2004 Nov. 39(11):1117-9. [Medline].

  13. Murali A, Narasimhan D, Krishnaveni J, Rajendiran G. Protein losing enteropathy in systemic lupus erythematosus. J Assoc Physicians India. 2013 Oct. 61(10):747-9. [Medline].

  14. Lim DH, Kim YG, Bae SH, et al. Factors related to outcomes in lupus-related protein-losing enteropathy. Korean J Intern Med. 2015 Nov. 30 (6):906-12. [Medline].

  15. Vyas H, Driscoll DJ, Cetta F, et al. Gastrointestinal bleeding and protein-losing enteropathy after the Fontan operation. Am J Cardiol. 2006 Sep 1. 98(5):666-7. [Medline].

  16. John AS, Johnson JA, Khan M, et al. Clinical outcomes and improved survival in patients with protein-losing enteropathy after the Fontan operation. J Am Coll Cardiol. 2014 Jul 8. 64(1):54-62. [Medline].

  17. Dori Y, Keller MS, Fogel MA, et al. MRI of lymphatic abnormalities after functional single-ventricle palliation surgery. AJR Am J Roentgenol. 2014 Aug. 203 (2):426-31. [Medline].

  18. Patel JK, Loomes KM, Goldberg DJ, Mercer-Rosa L, Dodds K, Rychik J. Early impact of Fontan operation on enteric protein loss. Ann Thorac Surg. 2015 Nov 30. [Medline].

  19. Waldmann TA. Protein-losing gastroenteropathy. Gastroenterology. 1966. 50:422.

  20. Chau TN, Mok MY, Chan EY, Luk WH, Lai KB, Li FT, et al. Evaluation of performance of measurement of faecal a(1)-antitrypsin clearance and technetium-99m human serum albumin scintigraphy in protein-losing enteropathy. Digestion. 2011. 84(3):199-206. [Medline].

  21. Furfaro F, Bezzio C, Maconi G. Protein-losing enteropathy in inflammatory bowel diseases. Minerva Gastroenterol Dietol. 2015 Dec. 61 (4):261-5. [Medline].

  22. Bindl L, Buderus S, Bindl C, Lentze MJ. Protein-losing enteropathy: report of four cases and review of etiology, diagnostic work-up and treatment. Klin Padiatr. 2005. 217:201-210.

  23. Florent C, L'Hirondel C, Desmazures C, et al. Intestinal clearance of alpha 1-antitrypsin. A sensitive method for the detection of protein-losing enteropathy. Gastroenterology. 1981 Oct. 81(4):777-80. [Medline].

  24. Magdo HS, Stillwell TL, Greenhawt MJ, et al. Immune Abnormalities in Fontan Protein-Losing Enteropathy: A Case-Control Study. J Pediatr. 2015 Aug. 167 (2):331-7. [Medline].

  25. Albright F, Bartter FC, Forbes AP. The fate of human serum albumin administered intravenously to a patient with idiopathic hypoalbuminemia and hypoproteinemia. Trans Assoc Am Physicians. 1949. 204:62.

  26. Ferrante M, De Hertogh G, Penninckx F, et al. Protein-losing enteropathy in Crohn's disease. Clin Gastroenterol Hepatol. 2005 Jun. 3(6):A25. [Medline].

  27. Stark ME, Batts KP, Alexander GL. Protein-losing enteropathy with collagenous colitis. Am J Gastroenterol. 1992 Jun. 87(6):780-3. [Medline].

  28. Ozeki T, Ogasawara N, Izawa S, Mizuno M, Yanamoto K, Noda H, et al. Protein-losing Enteropathy Associated with Collagenous Colitis Cured by Withdrawal of a Proton Pump Inhibitor. Intern Med. 2013. 52(11):1183-7. [Medline].

  29. Jeffries GH, Chapman A, Sleisenger MH. Low-fat diet in intestinal lymphagiectasia: its effect on albumin metabolism. N Engl J Med. 1964. 270:761-4.

  30. Lee HJ, Rha MY, Cho YY, Kim ER, Chang DK. A case of protein supplement effect in protein-losing enteropathy. Clin Nutr Res. 2012 Jul. 1(1):94-8. [Medline]. [Full Text].

  31. Yeaton P, Frierson HF Jr. Octreotide reduces enteral protein losses in Ménétrier's disease. Am J Gastroenterol. 1993 Jan. 88(1):95-8. [Medline].

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