Protein losing enteropathy

Jump to navigation Jump to search

WikiDoc Resources for Protein losing enteropathy


Most recent articles on Protein losing enteropathy

Most cited articles on Protein losing enteropathy

Review articles on Protein losing enteropathy

Articles on Protein losing enteropathy in N Eng J Med, Lancet, BMJ


Powerpoint slides on Protein losing enteropathy

Images of Protein losing enteropathy

Photos of Protein losing enteropathy

Podcasts & MP3s on Protein losing enteropathy

Videos on Protein losing enteropathy

Evidence Based Medicine

Cochrane Collaboration on Protein losing enteropathy

Bandolier on Protein losing enteropathy

TRIP on Protein losing enteropathy

Clinical Trials

Ongoing Trials on Protein losing enteropathy at Clinical

Trial results on Protein losing enteropathy

Clinical Trials on Protein losing enteropathy at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Protein losing enteropathy

NICE Guidance on Protein losing enteropathy


FDA on Protein losing enteropathy

CDC on Protein losing enteropathy


Books on Protein losing enteropathy


Protein losing enteropathy in the news

Be alerted to news on Protein losing enteropathy

News trends on Protein losing enteropathy


Blogs on Protein losing enteropathy


Definitions of Protein losing enteropathy

Patient Resources / Community

Patient resources on Protein losing enteropathy

Discussion groups on Protein losing enteropathy

Patient Handouts on Protein losing enteropathy

Directions to Hospitals Treating Protein losing enteropathy

Risk calculators and risk factors for Protein losing enteropathy

Healthcare Provider Resources

Symptoms of Protein losing enteropathy

Causes & Risk Factors for Protein losing enteropathy

Diagnostic studies for Protein losing enteropathy

Treatment of Protein losing enteropathy

Continuing Medical Education (CME)

CME Programs on Protein losing enteropathy


Protein losing enteropathy en Espanol

Protein losing enteropathy en Francais


Protein losing enteropathy in the Marketplace

Patents on Protein losing enteropathy

Experimental / Informatics

List of terms related to Protein losing enteropathy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Zarlakhta Zamani, M.B.B.S[] Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Synonyms and keywords: Protein loss, protein deficiency, GI protein loss, gastrointestinal protein loss, protein-losing gastroenteropathy, protein-losing gastroenteropathy, gastroenteropathy, gastric protein loss, helicobacter pylori, H pylori, giant hypertrophic gastropathy, menetrier disease, ménétrier, disease, loss of plasma proteins from the gastrointestinal tract, excessive leakage of plasma proteins into the lumen of the gastrointestinal tract, lymphatic obstruction, mucosal disease with erosions, ulcerations, swelling of the legs, peripheral edema, decreased plasma oncotic pressure


Protein losing enteropathy is the loss of plasma proteins from the gastrointestinal tract caused by an array of abnormalities, such as primary gastrointestinal diseases and lymphatic obstruction. Protein losing enteropathy is not a separate disease entity but a complication of different pathological conditions leading to hypoproteinemia. Treatment is tailored towards the underlying etiology leading to protein losing enteropathy as a complication.

Historical Perspective

  • There is no historical significance associated with protein losing enteropathy.


  • There is no classification for protein losing enteropathy according to recent updates.


Normally there is a balance between the synthesis and degradation of proteins maintained by a series of interconnected processes in the body. Any condition which disrupts the normal protein stasis where the loss of protein through the gastrointestinal tract exceeds the body’s ability to synthesize proteins failing to compensate for the loss leads to the development of a state of low serum protein called hypoproteinemia.[1][2] [3]


Most cases of protein losing enteropathy are caused as a result of:

  1. Primary gastrointestinal diseases
  2. Lymphatic obstruction

Primary Gastrointestinal Diseases

Mucosal Erosions/Ulcerations

Primary gastrointestinal diseases causing erosion or ulceration of the mucosa of the gut leading to fecal loss of proteins such as:[1][5][6]

Non-Erosive/Ulcerative Mucosal involvement

Lymphatic Obstruction

Conditions responsible for causing lymphatic obstruction leading to the leakage of lymph into the lumen of gut such as:

Complete Differential Diagnosis Of Underlying Causes

Protein losing enteropathy must be differentiated from any condition causing hypoproteinemia. Some common condition are listed below:[11] [12] [13] [14] [15]


As hypoproteinemia is the key factor in evaluating a patient for protein losing enteropathy, other common causes of hypoproteinemia such as nephrotic syndrome, impaired protein synthesis due to chronic liver disease and malnutrition must be excluded first.[16]

Laboratory Studies

As the most prominent laboratory finding is a decrease in serum concentration of albumin and globulin, the diagnostic work up protein losing enteropathy consist of quantitative measurements of Alpha-1 antitrypsin or 51Cr-albumin.[17]

  • Alpha 1-AT plasma concentration = ((stool volume) x (stool alpha 1-AT)) / (serum alpha-1 AT)
  • 51Cr-labeled albumin can also be measured followed by stool collection to determine the amount of protein loss into the gastrointestinal tract.

Imaging Studies

Following the detection of abnormal amounts of alpha-1 antitrypsin in the stool, the following tests can be performed to detect the specific etiology for the protein loss into the gastrointestinal lumen.[17]

Other tests:


  • Symptomatic relief can be achieved with dietary modifications and medications.
  • However, protein losing enteropathy is not a separate disease entity but a complication of different pathological conditions and hence the mainstay of treatment depends upon the underlying etiology of the disease causing protein losing enteropathy.


  1. 1.0 1.1 Craven, Melanie D.; Washabau, Robert J. (2019). "Comparative pathophysiology and management of protein‐losing enteropathy". Journal of Veterinary Internal Medicine. 33 (2): 383–402. doi:10.1111/jvim.15406. ISSN 0891-6640.
  2. 2.0 2.1 "StatPearls". 2020. PMID Check |pmid= value (help).
  3. Waldmann, T.A.; Wochner, R.D.; Strober, W. (1969). "The role of the gastrointestinal tract in plasma protein metabolism". The American Journal of Medicine. 46 (2): 275–285. doi:10.1016/0002-9343(69)90011-4. ISSN 0002-9343.
  4. Craven MD, Washabau RJ (2019). "Comparative pathophysiology and management of protein-losing enteropathy". J Vet Intern Med. 33 (2): 383–402. doi:10.1111/jvim.15406. PMC 6430879. PMID 30762910.
  5. Akkelle BS, Tutar E, Sengul OK, Celikel CA, Ertem D (2018). "A Rare Complication of Giardiasis in Children: Protein-losing Enteropathy". Pediatr Infect Dis J. 37 (12): e345–e347. doi:10.1097/INF.0000000000002025. PMID 30408010.
  6. Zubiaga Toro L, Ruiz-Tovar J, Castro MJ, Ortiz de Solórzano FJ, Luque de León E, Jiménez JM; et al. (2019). "Whipple disease after bariatric surgery: from malabsorption to malnutrition status". Nutr Hosp. 36 (1): 238–241. doi:10.20960/nh.02258. PMID 30834767.
  7. Venkatesh, Balasubramanian; Gough, Jenny; Ralston, David R.; Muller, Michael; Pegg, Stuart (2004). "Protein losing enteropathy in critically ill adult patients with burns: a preliminary report". Intensive Care Medicine. 30 (1): 162–166. doi:10.1007/s00134-003-2050-2. ISSN 0342-4642.
  8. Furfaro F, Bezzio C, Maconi G (2015). "Protein-losing enteropathy in inflammatory bowel diseases". Minerva Gastroenterol Dietol. 61 (4): 261–5. PMID 26446687.
  9. Amiot A (2015). "[Protein-losing enteropathy]". Rev Med Interne. 36 (7): 467–73. doi:10.1016/j.revmed.2014.12.001. PMID 25618488.
  10. "StatPearls". 2020. PMID 31194423.
  11. Tsochatzis, Emmanuel A; Bosch, Jaime; Burroughs, Andrew K (2014). "Liver cirrhosis". The Lancet. 383 (9930): 1749–1761. doi:10.1016/S0140-6736(14)60121-5. ISSN 0140-6736.
  12. Rieder, Simone C.; Huber, Lars C.; Trachsler, Johannes; Herberger, Elisabeth (2019). "CME: Das nephrotische Syndrom beim Erwachsenen: Präsentation, Abklärung, Therapie". Praxis. 108 (5): 347–355. doi:10.1024/1661-8157/a003223. ISSN 1661-8157.
  13. Grover, Zubin; Ee, Looi C. (2009). "Protein Energy Malnutrition". Pediatric Clinics of North America. 56 (5): 1055–1068. doi:10.1016/j.pcl.2009.07.001. ISSN 0031-3955.
  14. Clark, Ricketta; Johnson, Ragan (2018). "Malabsorption Syndromes". Nursing Clinics of North America. 53 (3): 361–374. doi:10.1016/j.cnur.2018.05.001. ISSN 0029-6465.
  15. Hazenberg, Bouke P.C. (2013). "Amyloidosis". Rheumatic Disease Clinics of North America. 39 (2): 323–345. doi:10.1016/j.rdc.2013.02.012. ISSN 0889-857X.
  16. Umar, Sarah B; DiBaise, John K (2010). "Protein-Losing Enteropathy: Case Illustrations and Clinical Review". American Journal of Gastroenterology. 105 (1): 43–49. doi:10.1038/ajg.2009.561. ISSN 0002-9270.
  17. 17.0 17.1 Levitt, David; Levitt, Michael (2017). "Protein losing enteropathy: comprehensive review of the mechanistic association with clinical and subclinical disease states". Clinical and Experimental Gastroenterology. Volume 10: 147–168. doi:10.2147/CEG.S136803. ISSN 1178-7023.
  18. Karbach U, Ewe K (1989). "Enteric protein loss in various gastrointestinal diseases determined by intestinal alpha 1-antitrypsin clearance". Z Gastroenterol. 27 (7): 362–5. PMID 2475983.
  19. Florent C, L'Hirondel C, Desmazures C, Aymes C, Bernier JJ (1981). "Intestinal clearance of alpha 1-antitrypsin. A sensitive method for the detection of protein-losing enteropathy". Gastroenterology. 81 (4): 777–80. PMID 6973500.
  20. Rychik, Jack; Spray, Thomas L. (2002). "Strategies to treat protein-losing enteropathy". Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual. 5 (1): 3–11. doi:10.1053/pcsu.2002.31498. ISSN 1092-9126.