Enteropathy is a pathological condition within the intestines. It develops as a complication of many different diseases, e.g. intestinal diseases, systemic diseases of connective tissue, malabsorption or gastrointestinal infections.
Protein-loss enteropathy (also called exudative enteropathy) is a syndrome of symptoms associated with severe loss of plasma proteins into the intestine. A healthy person loses as much protein per day as is simultaneously produced in the liver. This is a normal physiological process. When a disease leading to enteropathy develops, the liver is unable to produce more proteins – the one that will meet the body’s needs and at the same time compensate for protein losses that have penetrated the gastrointestinal mucosa. What happens then? There is an abnormally low concentration of albumin in the blood serum. Symptoms of this are tissue edema and fluid seepage into natural body cavities, e.g. the peritoneum or pleura. There are two groups of diseases among the causes of protein-loss enteropathy. The former are related to the loss of lymph, the latter to the loss of proteins through the gastrointestinal mucosa.
Lymph loss is caused by heart disease (right ventricular failure, pericarditis, birth defects), damage to the lymphatic system (sarcoidosis, radiotherapy and chemotherapy used in the treatment of cancer), diseases that damage the liver (cirrhosis, hepatic venous thrombosis) and congenital defects of the lymphatic system (intestinal lymphangioma).
The cause of protein loss through the gastrointestinal mucosa may be gastric and duodenal ulcer disease, overuse of painkillers and anti-inflammatory drugs, Crohn’s disease, ulcerative colitis, systemic diseases of the connective tissue (systemic lupus erythematosus, rheumatoid arthritis), haemorrhagic mucositis and gastric cancer, celiac disease, infection of the gastrointestinal tract by bacteria or parasites.
A range of symptoms
The symptoms of protein-loss enteropathy vary widely. The most common symptom of the disease is long-lasting, debilitating, fatty diarrhea and associated significant weight loss.
There are generalized edema, fluid accumulation in the pleura, the pericardial sac and in the abdominal cavity (ascites). Another symptom is unpleasant stomach pains. Deficiency of vitamin A, which dissolves in fat, is manifested by unpleasant dry skin, acne, often dry eye syndrome, night blindness (also called night blindness), brittleness and slow growth of nails. Lack of appetite may appear. Vitamin D deficiency leads to a decrease in bone mass, which results in pathological fractures, conjunctivitis, skeletal degeneration and dermatitis.
Recognition by exclusion
There are no specialized tests, the performance of which allows us to conclusively state that the patient suffers from protein-losing enteropathy. The patient’s doctor must concentrate on whether the symptoms are caused by another disease.
The diagnosis usually begins with a blood test (low total protein and albumin). Cholesterol is also measured in the blood, since cholesterol levels are significantly increased in the blood with enteropathy. Faeces are also tested, which allows the amount of alpha1-antipersin excreted (it is increased) to be determined. An ultrasound or CT scan of the abdominal cavity shows swelling in the walls of the small intestine. If the diagnosis is unsure, the doctor recommends an endoscopic examination, during which a sample is taken for histopoathological examination. Then, the material is observed under a microscope, which shows the atrophy of intestinal villi, infiltration and swelling of the mucosa.
How is it treated?
Treatment always begins with an attempt to control the disease that causes protein-wasting entaropathy. Once it is healed, the problem disappears. Other elements of the therapy are diet and taking properly selected medications.
Protein-wasting enteropathy must have a high-protein diet. This means that a person must consume up to 3 grams of protein per day for every kilogram of body weight. It is also necessary to significantly reduce salt and fats.
Pharmacological treatment consists mainly in supplementing the deficiencies of vitamins and microelements. Periodically, the patients are administered orally dehydrating drugs, and intravenously, albumin (proteins) and blood plasma. If the course of the disease is particularly turbulent, then parenteral nutrition is necessary.
In any case of protein-losing enteropathy, the success of therapy depends on the underlying disease, which is complicated by protein-losing enteropathy. If the underlying disease is systemic lupus erythematosus, Crohn’s disease, a complete cure is not possible. One can only achieve a periodic improvement in the patient’s well-being. When the cause of enteropathy was the abuse of painkillers or anti-inflammatory drugs, or gastric and duodenal ulcer disease – you can count on success after eliminating the cause of the disease.
Chronically ill people who develop enteropathy must be under the care of specialists so that in the event of an exacerbation of enteropathy they can implement appropriate treatment, e.g. administering dehydrating drugs and albumin. An important part of maintaining well-being is regular check-ups and adherence to a diet.
In some cases, it is difficult to avoid protein-losing enteropathy. It happens when we develop lupus, celiac disease or Crohn’s disease. However, people who overuse painkillers or anti-inflammatory drugs can control their behavior. Even when pain is the cause of taking them, you can still use painkiller ointments or patches. Transdermal (transdermal) administration of this group of drugs does not damage the intestinal mucosa.
Tekst: Anna Jarosz