- 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 (detected as hypoalbuminemia), 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 pathogenesis, clinical manifestations, diagnosis and treatment 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 gastroenteropathies can be caused by a diverse group of disorders (table 1). The increase in intestinal leakage of plasma proteins occurs via one of two mechanisms:
●Mucosal injury with or without erosions/ulcerations, as in inflammatory bowel disease (IBD) and celiac disease.
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- CLINICAL MANIFESTATIONS
- DISEASES ASSOCIATED WITH MUCOSAL DAMAGE, EROSIONS, AND ULCERATIONS
- DISEASES ASSOCIATED WITH MUCOSAL DISEASE WITHOUT ULCERATIONS
- Intestinal disease
- Giant hypertrophic gastropathy
- Waldenstrom macroglobulinemia
- DISEASES ASSOCIATED WITH IMPAIRED LYMPHATIC DRAINAGE
- Primary intestinal lymphangiectasia
- - Clinical manifestations
- - Diagnosis
- - Treatment
- Secondary intestinal lymphangiectasia
- - Cardiac diseases
- Maintenance of nutrition
- Treatment of the underlying disease
- SUMMARY AND RECOMMENDATIONS