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[Protein-losing gastroenteropathies in children. Clinical, laboratory and therapeutic observations in 13 patients]
M I Fernandes1, L E Troncon, N Iazigi
1Departamento de Puericultura e Pediatria da Faculdade de Medicina de Ribeirão Preto.
Insights
Protein-losing gastroenteropathy in children is characterized by significant protein loss, leading to malnutrition and edema. Early diagnosis and treatment are crucial for managing this complex gastrointestinal disorder.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Internal Medicine
Background:
- Protein-losing gastroenteropathy (PLG) is a rare condition characterized by excessive loss of serum proteins into the gastrointestinal tract.
- This abstract presents a series of pediatric cases highlighting the diverse clinical manifestations and etiologies of PLG.
Observation:
- Thirteen children with confirmed PLG, aged 3 months to 12 years, exhibited symptoms including diarrhea, edema, anorexia, and malnutrition.
- Low serum albumin levels (average 1.7 g/100 ml) and compromised fat absorption were common findings.
- Etiologies varied, including paracoccidioidomycosis, enteric lymphangiectasia, and cow's milk allergy.
Findings:
- Diarrhea and peripheral edema were the most frequent clinical signs in pediatric PLG patients.
- Malnutrition, particularly first and second-grade, was observed in 10 out of 13 children.
- Multiple underlying causes were identified, emphasizing the need for comprehensive diagnostic workup.
Implications:
- Understanding the diverse etiologies of PLG is essential for targeted diagnosis and effective treatment strategies in children.
- Early identification of protein loss and malnutrition can significantly improve patient outcomes.
- Further research into the mechanisms of protein loss in PLG is warranted to refine therapeutic approaches.
Abstract:
Thirteen children carrying protein-losing gastroenteropathy confirmed by the excretion fecal 51Cr albumin are presented. The ages ranged from 3 months to 12 years old, and the mean age of onset of symptom was 6 years 11 months old. Symptoms initiated between 3 to 7 years old in 11 patients. First and second grade malnutrition were detected within 10 cases. The most frequent clinical observation was diarrhea, found in 11 patients, followed by peripheral edema (10), anorexia (10), paleness (10), muscular hypotrophy (9), abdominal distension (8), ascite (7), wasted (7) and vomiting (5). The serum albumin level was below 2.5 g/100 ml in 12 patients, with and average of 1.7 g/100 ml. The gammaglobulin fraction was below 1.0 g/100 ml in 8 patients and lymphocytopenia in 5. Tests have shown a compromised fat absorption, thus, 7 among 8 lipiodol's test were negatives. The etiologic diagnosis were: paracoccidioidomycoses (5 patients), primary enteric lymphangiectasia (1), stronglyoidiasis (1), constrictive pericarditis (1), rheumatic carditis with double mitral lesion (1), Ménétrier's disease (1), short gut malabsorption syndrome (1), celiac disease (1) and cow's milk allergy (1). The responsible mechanism for the great loss of proteins to the digestive tube as well as diagnose and therapeutic aspects of the patients are commented. A report of 4 cases was done, as a way to show the pathology more characteristically due to protein losing gastroenteropathy.