- Vladan Milovic, MD, PhD
Vladan Milovic, MD, PhD
- Associate Professor of Medicine
- Head, Department of Gastroenterology & Oncology Reha-Zentrum Bad Reichenhall /
- Bayerisch Gmain Klinik Hochstaufen Bayerisch Gmain
- Bayern, Germany
- Richard J Grand, MD
Richard J Grand, MD
- Professor of Pediatrics
- Boston Children's Hospital
- Harvard Medical School
Protein-losing gastroenteropathies are characterized by an excessive loss of serum proteins into the gastrointestinal tract, resulting in hypoproteinemia, edema, and, in some cases, pleural and pericardial effusions. The diagnosis of protein-losing gastroenteropathy should be considered in patients with hypoproteinemia in whom other causes, such as malnutrition, heavy proteinuria, and impaired protein synthesis, due to liver diseases, have been excluded.
This topic will review the etiology, pathogenesis, clinical manifestations, diagnosis and management of protein-losing gastroenteropathy. Other causes of hypoalbuminemia are discussed elsewhere. (See "Clinical features and diagnosis of malabsorption", section on 'Protein malabsorption' and "Mechanisms of nutrient absorption and malabsorption", section on 'Protein absorption' and "Overview of heavy proteinuria and the nephrotic syndrome" and "Tests of the liver's biosynthetic capacity (eg, albumin, coagulation factors, prothrombin time)", section on 'Albumin'.)
The normal gastrointestinal tract does not contribute significantly to the catabolism of plasma proteins, accounting for only about 10 percent of the normal turnover of albumin and gamma globulin . Once plasma proteins pass into the gastrointestinal tract, they are degraded rapidly to amino acids and reabsorbed into the portal circulation.
Protein-losing gastroenteropathy can be caused by a diverse group of disorders (table 1). Intestinal leakage of plasma proteins occurs via one of the following mechanisms:
●Inflammatory exudation – Mucosal injury results in exudation of protein-rich fluids across the eroded epithelium. The degree of mucosal involvement typically correlates with the severity of protein loss.
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- Erosive gastrointestinal diseases
- Nonerosive gastrointestinal diseases
- Diseases with lymphatic obstruction
- CLINICAL FEATURES
- Clinical manifestations
- Laboratory findings
- POST-DIAGNOSTIC EVALUATION
- Our approach
- History and physical examination
- Laboratory studies
- Abdominal imaging
- Endoscopy and biopsy
- Additional testing
- DIFFERENTIAL DIAGNOSIS
- Dietary therapy
- Treatment of the underlying disease
- SUMMARY AND RECOMMENDATIONS