Protein losing enteropathy (PEL) is an uncommon condition characterized by excessive loss of plasma protein into the intestine. This may lead to symptoms of hypoproteinemia such as swelling of legs, diarrhea, fluid buildup in abdomen (ascites), lungs (pleural effusion) etc.
Protein is lost either due to damage in the gastrointestinal wall or from obstruction of lymph flow through the abdominal lymphatic system or as a result of problems that cause rise in central venous pressure.
Common causes of hypoprotinemia such as malnutrition, proteinuria (loss of protein through urine), disorders of liver such as cirrhosis must be ruled out. Treatment of protein losing gastroenteropathy consists of managing the underlying condition, dietary modification, and eating healthy nutritional food.
Causes Of Protein Losing Enteropathy In Humans
Protein losing enteropathy as mentioned above is a condition in which there is substantial loss of protein resulting in hypoproteinemia. The loss is not limited only from intestine but it can also occur through stomach and esophagus in some cases. Normally protein loss from the intestinal lining is very marginal which accounts for 2 percent of the total body protein.
This loss can occur as a result of injury to the intestinal lining which can make the mucosal lining more permeable. Other important reason is obstruction of the abdominal lymphatic channel. It leads to leaking of the lymph into the gut. Lymph fluid is high in protein content. Certain liver condition which does not allow liver to synthesize protein can also cause protein losing enteropathy.
There are diverse group of disorders that may cause protein losing enteropathy. This can be grouped as under;
PEL due to damage to the gastrointestinal lining;
- Ulcerative colitis
- Stomach cancer
- Cancer of esophagus
- Gastric ulcer
- Lymphosarcoma of the intestine.
PEL caused due to blockage of lymph fluid;
- Primary intestinal lymphangectasia.
- Blockage of abdominal lymph flow secondary to conditions like congestive cardiac failure, fibrosis of peritoneum, sarcoidosis and tuberculous infection.
Causes that may lead to leakage from tiny capillaries of intestinal mucosa;
- Viral gastroenteritis
- Hookworm and giardia infection
- Zollinger- Ellison syndrome
- Allergic enteritis
- Systemic lupus erythema
Other systemic diseases and conditions such as burns, AIDS, Cytomegalovirus, can also cause protein losing enteropathy.
Symptoms Of Protein Losing Enteropathy
Symptoms of protein losing enteropathy may be diverse as there are many underlying causes. However, swelling in legs and face is the main common symptom that is apparent due to hypoproteinemia. Some other symptoms are as follows;
- Abdominal pain and discomfort.
- Swelling in ankles, face under the eyes.
- Chronic diarrhea.
- Black tarry stools due to leakage of blood from gastric or duodenal ulcer.
- Weight loss as protein absorption is affected due to injury to the internal mucosa of intestine.
- Recurrent infections due to low immunity especially when there is obstruction in the abdominal lymphatic channel.
- Abdominal distension due to accumulation of fluid in the abdomen.
- Breathlessness due to accumulation of fluid in the pleura of the lungs.
Treatment Options For Protein Losing Enteropathy
After diagnosis of protein losing enteropathy, the main line of treatment is to address the underlying cause that is responsible for this condition. At the same time the body needs to be replenished with protein that has been lost through the gut. It also needs dietary supplements of vitamins and minerals as most patients are deficient in them due to lack of absorption.
Most cases of protein losing enteropathy are treated conservatively with medicines but sometimes surgical intervention may be necessary depending on the cause. For example gastric or peptic ulcer where H.pylori organism is the culprit is treated conservatively with medicines. Other diseases of intestine may be managed well with the use of antibiotics. If there is hookworm infection, medicines are prescribed to get rid of the parasite. In cases such as gastric cancer surgery may be necessary.
Patient has to modify his diet. He should eat foods that are high in protein. If there is swelling in foot, wearing compression stocking is beneficial. Patients suffering from celiac disease needs to eat gluten free diet.