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[Investigation of protein-losing enteropathy in pediatric patients]
C Sierra Salinas1, M I Vicioso Recio, A Barco Galvez
1Unidad de Gastroenterología y Nutrición Infantil, Hospital Materno Infantil, Málaga.
Insights
Protein-losing enteropathy is common in pediatric cardiac and gastrointestinal diseases. Fecal alpha-1-antitrypsin excretion and intestinal clearance effectively diagnose this condition.
Area of Science:
- Pediatric Gastroenterology
- Cardiology
- Clinical Diagnostics
Background:
- Enteric protein loss is often overlooked in pediatric patient management.
- Conditions like heart disease and gastrointestinal disorders can be associated with protein loss.
Observation:
- A study compared fecal alpha-1-antitrypsin excretion and intestinal clearance in healthy children, pediatric cardiac patients, and pediatric gastrointestinal patients.
- Patients with cardiac or gastrointestinal issues were selected due to high right heart pressure, lymphatic anomalies, or mucosal inflammation/ulceration.
Findings:
- Both fecal alpha-1-antitrypsin excretion and intestinal clearance methods showed high correlation (r = 0.7542).
- Protein-losing enteropathy was diagnosed in a significant percentage of pediatric cardiac (60%) and gastrointestinal (35%) patients.
- Clearance values correlated significantly with plasma protein levels (e.g., albumin, transferrin).
Implications:
- Protein-losing enteropathy is prevalent in pediatric patients with cardiac or gastrointestinal conditions.
- The study validates alpha-1-antitrypsin methods for diagnosing enteric protein loss in children.
- Early diagnosis and management of protein loss can improve clinical outcomes in affected children.
Objective:
Our objective was to investigate enteric los of proteins in a group of selected patients, which frequently is not taken into account in the clinical management of these patients.
Patients And Methods:
We included 20 healthy children (group I), 10 pediatric patients with heart disease (group II) and 20 pediatric patients with gastrointestinal disease (group III). They were selected because a high percentage of them had high right heart chamber pressure and/or lymphatic anomalies or inflammation and/or ulceration of the gastrointestinal mucosa. A double study method was performed, including excretion of fecal alpha-1-antitrypsin and intestinal clearance of alpha-1-antitrypsin.
Results:
A high correlation between both methods (r = 0.7542, p < 0.001) was found. Normal values were obtained for the excretion of fecal alpha-1-antitrypsin (< 1.6 mg/g of dry feces) and for clearance (< 26.5 ml/day) in group I. Protein-losing enteropathy was diagnosed in 60% of cardiac patients and 35% of patients with gastrointestinal disease when applying the method of fecal alpha-1-antitrypsin excretion and in 50% and 40%, respectively, when using the clearance method. There is a high correlation between the clearance and plasma protein level (r = -0.7162, p < 0.001 for albumin, r = -0.5239, p < 0.01 for transferrin, r = -0.4609, p < 0.05 for prealbumin). The regression line crosses the albumin concentration of 3 g/dl when the clearance is 176 ml/day, a similar result to that seen in adult patients.
Conclusions:
Protein-losing enteropathy is detected in a high proportion of pediatric patients affected by cardiac or gastrointestinal disease. There is a close correlation between fecal excretion and intestinal clearance of alpha-1-antitrypsin.