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Random fecal alpha-1-antitrypsin concentration in children with gastrointestinal disease
Insights
Fecal alpha-1-antitrypsin is a valuable screening tool for gastrointestinal mucosal disorders causing protein loss in children. Elevated levels indicate conditions like celiac disease and inflammatory bowel disease.
Area of Science:
- Pediatric Gastroenterology
- Clinical Biochemistry
Background:
- Protein-losing enteropathy (PLE) is a significant complication in various pediatric gastrointestinal diseases.
- Diagnosing PLE often requires invasive or complex testing, necessitating simpler screening methods.
Purpose of the Study:
- To evaluate the utility of random fecal alpha-1-antitrypsin concentration as a non-invasive screening test for PLE in children.
- To correlate fecal alpha-1-antitrypsin levels with specific gastrointestinal diagnoses and disease activity.
Main Methods:
- Measured random fecal alpha-1-antitrypsin concentrations in 115 children, including controls and those with diverse gastrointestinal conditions.
- Compared fecal alpha-1-antitrypsin levels against established controls and correlated findings with diagnoses and clinical outcomes.
Main Results:
- Children with celiac disease, allergic gastroenteropathy, intestinal lymphangiectasia, nonspecific colitis, acute gastrointestinal bleeding, and active chronic inflammatory bowel disease showed significantly elevated fecal alpha-1-antitrypsin levels.
- Elevated levels were consistent with previously documented protein-losing enteropathy.
- Serial measurements paralleled disease activity and response to therapy.
Conclusions:
- Random fecal alpha-1-antitrypsin concentration is a sensitive and valuable screening test for identifying pediatric gastrointestinal mucosal disorders associated with protein loss.
- This non-invasive method can aid in early detection and management of conditions causing PLE.
Abstract:
Random fecal alpha-1-antitrypsin concentration was measured in children with various gastrointestinal diseases and in normal subjects. One hundred fifteen subjects were evaluated: controls (39); chronic inflammatory bowel disease (20); chronic diarrhea (18); acute gastroenteritis (17); allergic gastroenteropathy (5); chronic pancreatic exocrine insufficiency (4); acute gastrointestinal bleeding (4); nonspecific colitis (4); celiac disease (3); and intestinal lymphangiectasia (1). Mean fecal-alpha-1-antitrypsin for the controls was 0.98 mg/g lyophilized stool. All children with celiac disease, allergic gastroenteropathy, lymphangiectasia, nonspecific colitis, acute gastrointestinal bleeding, and 19 of 20 patients with active chronic inflammatory bowel disease had fecal alpha-1-antitrypsin concentrations greater than 2.6 mg/g stool (mean of the controls + 2 SD). These disorders have all been previously documented to cause protein-losing enteropathy by 51Cr-labeled albumin excretion tests. The other study patients had normal fecal alpha-1-antitrypsin excretion when compared with controls. Serial fecal antitrypsin concentrations paralleled disease activity and clinical response to therapy. The results suggest that random fecal antitrypsin concentration is a valuable screening test for mucosal disorders associated with abnormal transmucosal serum protein loss.
