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Protein-Losing Enteropathy Workup

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

Laboratory Studies

The most prominent laboratory abnormality is a decrease in serum albumin and globulin.

A gastrointestinal disorder should be considered the cause of hypoalbuminemia after malnutrition, nephrotic syndrome, and chronic liver disease are excluded. The diagnostic workup can then be focused on gastrointestinal causes.[22]

The presence of alpha1-antitrypsin in the stool is an important diagnostic clue because it is not normally absorbed or secreted into the bowel.[23]  In patients with hyperacidity syndromes, this study is not accurate because of the degradation of alpha1-antitrypsin in an environment where the pH is less than 3. Measuring stool volume and stool alpha1-antitrypsin concentration shows the plasma clearance (PC) of alpha1-antitrypsin.[23] The plasma clearance of alpha1-antitrypsin can be used to monitor response to therapy.

Alpha 1-AT PC = ((stool volume) x (stool alpha 1-AT)) / (serum alpha-1 AT)

Erythrocyte sedimentation rate and serum total cholesterol levels have reported to be significantly elevated in patients with lupus-related protein-losing enteropathy.{ref29)

Viral serologies may be helpful.

In a prospective study that evaluated the immunologic characteristics of patients with protein-losing enteropathy (PLE) following Fontan procedures and those without postoperative PLE, patients with postoperative PLE all had markedly low CD4 T cell counts compared to the control subjects.[24] Both groups had mildly decreased CD8 T cells and normal to slightly elevated natural killer and B cells.


Imaging Studies

Radionuclide-labeled serum albumin can be administered intravenously, and stool can be collected as a measure of protein exudation into the gastrointestinal tract.[25]

Computed tomography scanning may suggest lymphatic obstruction. This needs to be confirmed with lymphangiography.

Chest radiography, echocardiography, and radionuclide scanning of the heart detect cardiac disease.

Erosive or ulcerative conditions are diagnosed using radiographic contrast studies or, when possible, endoscopy and mucosal biopsies.

T2-weighted magnetic resonance imaging shows promise in the evaluation of lymphatic abnormalities in patients following functional single-ventricle palliative surgery.[17] Lymphatic anomalies might play a role in protein-losing enteropathy in this setting.


Other Tests

See the list below:

  • Primary gastrointestinal tract disease can be detected by endoscopy and biopsy, barium radiography, stools for ova and parasites, and culture. Primary gastrointestinal tract disease can be suggested by fecal occult blood.
  • Perform a hydrogen breath test for bacterial overgrowth in the small intestine.


See the list below:

  • Findings on endoscopic studies are usually normal unless primary gastrointestinal disease (eg, ulcerative colitis, Crohn disease, Ménétrier disease, viral mucosal ulcerations) is present. [26]

Histologic Findings

Mucosal abnormalities can be observed with inflammatory (colitis) and infectious (viral tuberculosis) causes and in lymphatic obstruction (lymphangiectasia).[27, 28]

Contributor Information and Disclosures

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.


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.

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