Published: 18 Jun 2025

ICD9: 579.8      ICD10: K52.22      ICD11: DA96.1

Protein-losing enteropathy (PLE) is a condition where the body abnormally loses proteins from the blood into the gastrointestinal (GI) tract.
This loss of protein leads to a significant drop in protein levels in the blood, particularly albumin, causing a variety of symptoms.

Think of it like a leaky pipe in your plumbing system. Instead of keeping the protein in the blood where it's needed, the GI tract is "leaky," allowing protein to seep out and be lost in the stool.

Here's a breakdown of key aspects of PLE:

Mechanism: The GI tract normally absorbs nutrients, but in PLE, the mechanisms that allow protein to stay in the bloodstream are compromised. This can be due to several factors.
Causes: Many underlying conditions can cause PLE. Some common causes include:

Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause inflammation and damage to the intestinal lining, leading to protein loss.
Intestinal Lymphangiectasia: This condition involves dilated or blocked lymphatic vessels in the intestines, preventing protein from being reabsorbed back into the bloodstream.
Heart Failure: Congestive heart failure can lead to increased pressure in the veins and lymphatic vessels in the intestines, causing protein leakage.
Constrictive Pericarditis: Inflammation and scarring of the sac surrounding the heart can impede blood flow and cause intestinal protein loss.
Certain Infections: Some infections can damage the intestinal lining and contribute to protein loss.
Tumors: Certain tumors in the GI tract can cause protein leakage.
Medications: Some medications may contribute to PLE.
Amyloidosis: Deposition of amyloid protein in various tissues, including the GI tract, can impair its function.
Symptoms: The symptoms of PLE are often related to low protein levels in the blood (hypoproteinemia) and can include:

Edema (Swelling): Swelling in the legs, ankles, feet, abdomen (ascites), or other parts of the body due to fluid shifting out of the blood vessels.
Fatigue and Weakness: Due to the lack of protein for energy and muscle maintenance.
Diarrhea: May be present, but not always.
Weight Loss: Unintentional weight loss can occur due to malabsorption and protein loss.
Abdominal Pain: May be present depending on the underlying cause.
Shortness of Breath: Fluid buildup in the lungs (pleural effusion) can cause breathing difficulties.
Diagnosis: Diagnosis usually involves:

Blood Tests: Low levels of albumin and total protein in the blood.
Stool Tests: Measuring the amount of alpha-1 antitrypsin (a protein) in the stool, which is elevated in PLE. This protein is relatively resistant to breakdown in the gut, so it serves as a marker for protein loss.
Endoscopy and Biopsy: To visualize the GI tract and take tissue samples for examination to identify the underlying cause.
Imaging Studies: X-rays, CT scans, or MRI to evaluate the GI tract and other organs.
Lymphangiography: To visualize the lymphatic vessels in the intestines.
Treatment: Treatment focuses on:

Addressing the Underlying Cause: The primary goal is to identify and treat the underlying condition causing the protein loss (e.g., treating IBD, managing heart failure).
Dietary Management: A high-protein diet, with careful attention to fat intake (depending on the cause), may be recommended. Sometimes, a diet low in long-chain triglycerides (LCTs) and supplemented with medium-chain triglycerides (MCTs) is used, especially if lymphatic obstruction is a factor.
Medications: Medications may be used to control symptoms, reduce inflammation, or treat the underlying cause. Examples include corticosteroids for inflammation, diuretics to reduce edema, and antibiotics for infections.
Albumin Infusions: In severe cases, albumin infusions may be necessary to temporarily raise protein levels in the blood.
Surgery: In some cases, surgery may be needed to correct structural abnormalities or remove tumors.

In summary, protein-losing enteropathy is not a disease in itself, but a consequence of other underlying conditions that cause abnormal protein loss from the gut. The goal of treatment is to identify and manage the primary condition, thereby reducing protein loss and alleviating symptoms. It's crucial to consult with a healthcare professional for proper diagnosis and management.