Protein losing enteropathy

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Protein losing enteropathy
ICD-9 579.8
OMIM 226300
DiseasesDB 10811
MedlinePlus 002277
MeSH D011504

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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

Overview

Protein losing enteropathy is the loss of plasma proteins from the gastrointestinal tract caused by an array of abnormalities

Historical Perspective

[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].

The association between [important risk factor/cause] and [disease name] was made in/during [year/event].

In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].

In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].

Presentation

  • The condition may manifest itself with complications related to protein loss, including edema, or retention of fluid, and ascites, or retention of fluid in the abdomen. Proteins are absorbed in the small bowel, and any condition that affects the digestion or absorption of protein can result in protein losing enteropathy.

Common Causes

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

  1. Primary gastrointestinal disorders
  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:

  • Inflammatory bowel diseases (Crohn disease, Ulcerative colitis)
  • Malignancies involving the gut mucosa
  • Graft vs. host disease
  • Esophageal and gastric erosions or ulcerations
  • Carcinoid syndrome
  • Bacterial infection with Clostridium difficile causing pseudomembranous colitis
  • Parasitic infection with Giardia
Non-Erosive/Ulcerative Mucosal involvement
  • Celiac Disease
  • Eosinophilic Gastritis
  • Hypertrophic Gastritis
  • Connective Tissue Disorders: Systemic Lupus Erythmatosis
  • Cutaneous burns

Lymphatic Obstruction

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

  • Lymphoma
  • Congenital or acquired lymphatic diseases
  • Lymphatic Filariasis
  • Sarcoidosis
  • Cardiovascular diseases: Congestive heart failure, Restrictive pericarditis
  • Intestinal Tuberculosis
  • Fortan surgical procedure
  • Cirrhosis with portal hypertension
  • Retroperitoneal fibrosis

Complete Differential Diagnosis Of Underlying Causes

Diagnosis

The diagnosis of protein losing enteropathy is typically made by excluding other causes of protein loss, such as nephrotic syndrome. Endoscopy and barium imaging can be used to localize the cause of the protein loss in the bowel.

Treatment

Treatment depends upon the underlying condition.

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