Approach to Protein-losing Enteropathy and Nutritional Management
Keywords:
protein-losing enteropathy, hypoalbuminemia, anasarca, nutritional managementAbstract
Patients with protein-losing enteropathy (PLE) usually present with anasarca from severe hypoalbuminemia. Clinical manifestations of PLE have to be differentiated from other causes of generalized edema including hepatic cirrhosis, proteinuria, and severe malnutrition. The diagnosis of PLE need a demonstration of abnormal gastrointestinal protein loss using either technetium-99m-, or indium-111-, labeled protein scintigraphy or -1 antitrypsin clearance. The etiologies of PLE can be grouped into 3 categories; the erosive gastrointestinal diseases, the non-erosive gastrointestinal diseases, and the diseases with increase lymphatic and interstitial pressure. The common investigations to identify cause of PLE usually involve fecal examination, test for fecal fat, computerized tomography of abdomen, gastrointestinal endoscopy and biopsy. The resolution of PLE is usually achieved by the control of primary disease. Proper nutritional management includes provision of adequate energy and higher protein intake up to 2-3 g/kg/day to combat the ongoing protein loss. Low fat diet with or without medium chained triglyceride supplement may help to reduce the symptoms of edema. Micronutrients statuses, particular those of fat-soluble vitamins, should be assessed and treated if deficient state is presence.
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