Protein-losing Gastroenteropathy Research Articles

Complete Remission of Protein-Losing Gastroenteropathy Associated With Sjögren's Syndrome by B Cell-Targeted Therapy With Rituximab

Complete Remission of Protein-Losing Gastroenteropathy Associated With Sjogren's Syndrome by B Cell-Targeted Therapy With Rituximab

A Case of Ménétrier Disease in a Child

Ménétrier disease is a protein-losing gastroenteropathy often misdiagnosed in the pediatric population. The disease is characterized by hypoalbuminemia secondary to protein loss through the gastrointestinal mucosa and resultant peripheral edema. It is important for emergency department practitioners to consider this diagnosis in the differential diagnosis for edema and low albumin levels in pediatric patients. We present a case report of Ménétrier disease in an edematous child and a brief review.

Protein-Loosing Entropathy Induced by Unique Combination of CMV and HP in an Immunocompetent Patient

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. Protein-losing gastroenteropathies can be caused by a diverse group of disorders and should be suspected in a patient with hypoproteinemia in whom other causes, such as malnutrition, proteinuria, and impaired liver protein synthesis, have been excluded. In this paper, we present a case of protein-losing enteropathy in a 22-year-old immunocompetent male with a coinfection of CMV and Hp.

A case of protein-losing gastroenteropathy accompanied by Sjögren syndrome and mixed connective tissue disease

A case of protein-losing gastroenteropathy accompanied by Sjögren syndrome and mixed connective tissue disease

Gastroenteropatía pierde proteínas: ¿causa olvidada de hipoalbuminemia?

Protein-losing gastroenteropathy (PLE) consists on an active digestive tract protein loss syndrome and it is related to some diseases. After a wide research into bibliography (MEDLINE - Pubmed),we have found few references to this gastroenteropathy as a cause of hypoalbuminemia related to malnutrition. This has motivated us to review this entity, detailing some recent clinical cases of our experience. (Nutr Hosp. 2011;26:1487-1489) DOI:10.3305/nh.2011.26.6.5404

Protein-losing gastroenteropathy: unremembered cause of hypoalbuminemia?

Protein-losing gastroenteropathy (PLE) consists on an active digestive tract protein loss syndrome and it is related to some diseases. After a wide research into bibliography (MEDLINE - Pubmed),we have found few references to this gastroenteropathy as a cause of hypoalbuminemia related to malnutrition. This has motivated us to review this entity, detailing some recent clinical cases of our experience.

Octreotide-Treated Diabetes Accompanied by Endogenous Hyperinsulinemic Hypoglycemia and Protein-Losing Gastroenteropathy

Occurrence of hypoglycemia in diabetes patients is very rare. We report here a case of frequent hypoglycemic attacks caused by inappropriate endogenous hyperinsulinemia in a female patient with poorly controlled diabetes and protein-losing gastroenteropathy. The blood glucose profiles of the patient were unstable. Results of the fasting test performed to investigate the cause of hypoglycemia suggested endogenous hyperinsulinism. Repeated selective arterial calcium injection tests suggested that hyperinsulinemia might be extrapancreatic in origin. However, efforts to detect a responsible lesion such as insulinoma were unsuccessful. Octreotide was used for the treatment of hypoglycemia and protein-losing gastroenteropathy. After treatment, although her leg edema caused by hypoalbuminemia persisted, hypoglycemia almost disappeared.

Gastric carcinoma with protein-losing gastroenteropathy: Report of a case

This report describes the successful treatment of a case of true gastric cancer presenting as protein-losing gastroenteropathy. A 58-year-old Japanese male presented gastric carcinoma. His serum albumin and total protein levels were 1.8 and 4.2 g/dl, respectively. He was diagnosed with gastric cancer with protein-losing gastroenteropathy based on (99m)Tc-human serum albumin scintigraphy. The patient underwent a total gastrectomy following neoadjuvant chemotherapy. There are 23 detailed case reports of gastric carcinoma with protein-losing gastroenteropathy. Most of these cases had large villous or cauliflower-like gastric tumors that were defined as papillary or well differentiated adenocarcinoma. Gastric cancer with protein-losing gastroenteropathy is extremely rare, but it can easily be diagnosed if the villous or cauliflower-like features are well defined.

Major gastrointestinal manifestations in lupus patients in Asia: lupus enteritis, intestinal pseudo-obstruction, and protein-losing gastroenteropathy

Gastrointestinal (GI) symptoms are common in patients with systemic lupus erythematosus (SLE) and may be due to the disease itself, side-effects of medications, or non-SLE causes. However, GI manifestations of lupus attract far less attention than the other major organ involvements, are infrequently reviewed and rarely documented in published lupus databases or cohort studies including those from countries in Asia. According to three reports from two countries in Asia, the cumulative prevalence of SLE GI manifestations range from 3.8% to 18%. In this review, we focus on three major GI manifestations in patients from Asian countries: lupus enteritis, intestinal pseudo-obstruction, and protein-losing gastroenteropathy, for which early recognition improves outcome and reduces morbidity and mortality.

Diagnosis of Protein-Losing Gastroenteropathy By Using Double Balloon Enteroscopy (DBE) and Videocapsule Endoscopy (VCE)

Background and Aims: Protein-losing gastroenteropathy often remains undiagnosed with conventional imaging modalities. Double balloon enteroscopy (DBE) and videocapsule endoscopy (VCE) enabled visual diagnosis of diseases deep in the small bowel. In this study, We aim to determine the usefulness of VCE and DBE for the diagnosis of protein-losing gastroenteropathy. Methods: Of 553 consecutive patients who underwent DBE between June 2003 and November 2008, 12 patients (7 men and 5 women, mean age 45.0) had presented with hypoproteinemia (n=12), edema (n=8), chronic diarrhea (n=6), anemia (n=6), ascites (n=1), and pleural effusion (n=1). These 12 patients were diagnosed as protein-losing gastroenteropathy by 99mTc-HSA-D scintigraphy and/or α1-antitrypsin clearance. They underwent DBE, VCE and double-contrast fluoroscopic enteroclysis, then the diagnostic yields of these examinations were compared. To rule out malabsorption syndrome, fecal Sudan III stain, D-xylose test, and bentiromide test was performed. Results: Final diagnosis were as follows; primary lymphangiectasia (n=3), non specific multiple ulcers (n=3), amyloidosis (n=2), simple ulcer syndrome (n=1), malignant lymphoma (n=1), secondary enteropathy associated with heart failure (n=1), and liver cirrhosis (n=1). DBE showed abnormal findings in 9/12 (75.0%) and enabled final diagnosis in 10 of 12 (83.3%) in addition to pathologic findings of biopsy specimens. VCE showed abnormal findings in 4/5 (80%) and enabled final diagnosis in 2/5(40%). fluoroscopic enteroclysis showed abnormal findings and enabled final diagnosis in 2/7 (28.6%). One patient could not be diagnosed as primary lymphangiectasia by VCE or DBE with biopsy in life and died of congestive heart failure. Autopsy revealed lymphangiectasia in the submucosal layer but not in the mucosal layer, which had caused no typical findings in the biopsy specimens at DBE. For evaluation of malabsorption syndrome, fecal Sudan III stain was performed in 4 patients, a D-xylose test in 2, and a bentiromide test in 4, but all was negative. Treatment was as follows; albumin infusion (n=7), elemental diet (n=6), corticosteroid (n=5), diuretic (n=5), octreotide (n=3), tranexamic acid (n=1), low fat diet with medium-chain triglycerides (n=1), 5-aminosalicylic acid (n=1), chemotherapy (n=1). Conclusions: Non-invasive visual observation throughout the small bowel at VCE and pathologic findings by biopsy specimens at DBE was useful for the diagnosis of protein-losing enteropathy. As biopsies at DBE were impossible to detect submucosal lymphangiectasia in one case, boring biopsy, jumbo biopsy, or enteroscopic mucosal resection may have been useful.

Central Serous Chorioretinopathy during Treatment of Systemic Lupus Erythematosus with Protein-losing Gastroenteropathy

症例は52歳，女性．下腿浮腫・呼吸困難にて入院．SLEに伴う漿膜炎および蛋白漏出性胃腸症と診断した．プレドニゾロン（prednisolone；PSL）を増量後，中心性漿液性網脈絡膜症（central serous chorioretinopathy；CSC）を発症した．CSC増悪とPSL増量の関連を考え,シクロホスファミドパルス療法（IVCY）併用下にPSLを減量し，漿膜炎・蛋白漏出性胃腸症・CSCとも改善して退院した．免疫抑制薬併用によりPSL減量を早め多彩な病態をコントロールできた点で貴重な症例であった．

Rheumatoid Arthritis Complicated with Protein-losing Gastroenteropathy and Malabsorption Syndrome

Rheumatoid Arthritis Complicated with Protein-losing Gastroenteropathy and Malabsorption Syndrome

Protein-losing gastroenteropathy associated with primary Sjögren’s syndrome: a characteristic oriental variant

Protein-losing gastroenteropathy (PLGE) is a rare manifestation of primary Sjögren's syndrome (SS). We report a case of a 41-year-old Japanese man, who is the first male patient, with PLGE associated with primary SS. Although serum anti-SSA and SSB antibodies were detected, he had no subjective sicca symptoms. He had multiple annular erythema: a characteristic skin manifestation of Asian SS patients. A diagnosis of PLGE was made from results of (99m)Tc-labelled albumin scintigraphy and a faecal alpha-1-antitrypsin clearance test. Intravenous administration of high-dose glucocorticoid was not effective, but pulse methylprednisolone therapy alleviated disease manifestations. As all cases of PLGE associated with primary SS have been reported from East Asia, this complication could be essentially limited to Asian patients.

The Edematous Toddler

Ménétrier disease is a protein-losing gastroenteropathy, characterized clinically by nonspecific gastrointestinal symptoms and generalized edema, biochemically by hypoalbuminemia, and pathologically by enlarged gastric folds. Distinct from its adult counterpart, Ménétrier disease of childhood usually remits spontaneously and has a very good prognosis. We present a case report of Ménétrier disease in an edematous toddler and a brief review.

Pemphigus vulgaris as a possible cause of protein‐losing gastroenteropathy: A case report

We present a case of pemphigus vulgaris (PV) accompanied with protein-losing gastroenteropathy (PLE). A 9-year-old girl developed multiple oral ulcerations and erosions. She was first treated with oral antibiotics and a topical steroid without improvement. Laboratory data showed eosinophilia (absolute eosinophil count 1.08 x 10(9)/L) and hypoproteinemia (total serum protein 3.9 g/dL, albumin 2.2 g/dL). A biopsy specimen from the ileum showed intense eosinophil infiltration and albumin scintigraphy demonstrated protein exduation from the same site. Endoscopic examination of the oesophagus showed multiple ulcerations and erosions, and biopsy specimen showed eosinophilic spongiosis and immunohistologic staining demonstrated deposits of IgG and C3 in the intercellular space. Antidesmoglein-3 antibody elevated, she was diagnosed as PV complicated with PLE. Immunofluorescence study of a biopsy specimen from the terminal ileum showed no significant immunoglobulin or complement deposition, and autoantibody against intestinal mucosa was unclear in this case. Gastrointestinal evaluations should be considered in patients with hypoproteinemia associated with PV.

A case of lymphangioleiomyomatosis associated with protein-losing gastroenteropathy

A case of lymphangioleiomyomatosis associated with protein-losing gastroenteropathy

A case of recurrent gastrointestinal bleeding and protein-losing gastroenteropathy

A 40-year-old male with pentalogy of Fallot (a congenital heart defect with five anatomical components) presented with recurrent gastrointestinal bleeding. He had recently recovered from a heart operation, which was performed to reconstruct the right ventricular outflow tract. Laboratory tests and absorption tests, esophagogastroduodenoscopy, capsule endoscopy, human serum albumin scintigraphy, lymphoscintigraphy, CT and abdominal lymph-node histology. Intestinal lymphangiectasia with concurrent protein-losing gastroenteropathy and recurrent gastrointestinal bleeding. MANAGEMENT Despite a low-fat diet and surgical suturing of multiple small-bowel ulcerations the gastrointestinal bleeding continued. Serum albumin levels remained very low and severe lymphedema occurred. Unfortunately, the patient developed severe sepsis and died of multiple organ failure.

Recurrent and Opportunistic Infections in Children With Primary Intestinal Lymphangiectasia

Recurrent and Opportunistic Infections in Children With Primary Intestinal Lymphangiectasia

On-Site Preparation of Technetium-99m Labeled Human Serum Albumin for Clinical Application

Technetium-99m labeled human serum albumin (Tc-99m HSA) is an important radiopharmaceutical for clinical applications, such as cardiac function tests or protein-losing gastroenteropathy assessment. However, because of transfusion-induced infectious diseases, the safety of serum products is a serious concern. In this context, serum products acquired from patients themselves are the most ideal tracer. However, the development of rapid separation and easy clinical labeling methods is not yet well established. Under such situation, products from the same ethnic group or country are now recommended by the World Health Organization as an alternative preparation. This article describes the on-site preparation of Tc-99m HSA from locally supplied serum products. Different formulations were prepared and the labeling efficiency and stability were examined. Radio-labeling efficiencies were more than 90% in all preparation protocols, except for one that omitted the stannous solution. The most cost-effective protocol contained HSA 0.1 mg, treated with stannous fluoride 0.2 mg, and mixed with Tc-99m pertechnetate 30 mCi. A biodistribution study was performed in rats using a gamma camera immediately after intravenous administration of radiolabeled HSA. Tissue/organ uptake was obtained by measuring the radioactivity in organs after sacrificing the rats at timed intervals. The biologic half-life was about 32 min, determined from sequential venous blood collections. These data indicate that our preparation of Tc-99m HSA is useful and potentially applicable clinically. In addition, this on-site preparation provides the possibility of labeling a patient's own serum for subsequent clinical application.

Eosinophilic gastroenteritis with cytomegalovirus infection in an immunocompetent child

A 3-year-old boy developed transient protein-losing gastroenteropathy associated with cytomegalovirus (CMV) infection. Both IgG and IgM antibodies to CMV were positive in a serologic blood test. Upper gastrointestinal endoscopy showed multiple erosions throughout the body of the stomach, without enlarged gastric folds. Histological examination of the biopsy specimens indicated eosinophilic gastroenteritis and CMV infection. The patient had complete resolution without specific therapy for CMV in four weeks. An allergic reaction as well as CMV infection played important roles in the pathogenesis of this case.