Endoscopic and imaging findings in protein-losing enteropathy

Hiroyuki Takenaka, Naoki Ohmiya, Yoshiki Hirooka, Masanao Nakamura, Eizaburo Ohno, Ryoji Miyahara, Hiroki Kawashima, Akihiro Itoh, Osamu Watanabe, Takafumi Ando, Hidemi Goto

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

OBJECTIVES: Protein-losing enteropathy (PLE) is often difficult to diagnose. We evaluated the diagnostic yields of underlying diseases of PLE among esophagogastroduodenoscopy, colonoscopy, fluoroscopic conventional enteroclysis (FCE), videocapsule endoscopy (VCE), and double-balloon enteroscopy (DBE) and prognosis after treatment. METHODS: Between June 2003 and August 2010, 25 consecutive patients with PLE confirmed by fecal α1-antitrypsin clearance (n=18) and technetium 99m human serum albumin scintigraphy (n=19) were enrolled, investigated, and treated. RESULTS: Of 25 patients, 4 (16%) with intestinal lymphangiectasia secondary to macroglobulinemia (n=1), amyloidosis (n=2), and strongyloidiasis (n=1) were diagnosed at preceding esophagogastroduodenoscopy or colonoscopy, and 7 (32%) with primary intestinal lymphangiectasia and chronic nonspecific multiple ulcers unrelated to nonsteroidal anti-inflammatory drugs of the small intestine were newly diagnosed at FCE or VCE. Other 11 (44%) patients with primary intestinal lymphangiectasia, small-bowel tumors, amyloidosis, chronic nonspecific multiple ulcers unrelated to nonsteroidal anti-inflammatory drugs of the small intestine, Crohn's disease, and small-bowel ulcers due to polyarteritis nodosa were diagnosed only at DBE with biopsy. Three patients with primary intestinal lymphangiectasia, cirrhosis after living donor liver transplantation, and congestive heart failure were not diagnosed at any small-bowel examination. The overall diagnostic yield of FCE, VCE, and DBE was 62% (8/13), 83% (14/17), and 88% (22/25), respectively. Eight patients (32%) died of underlying disorders regardless of medical treatment over the follow-up period. CONCLUSIONS: DBE with pathologic findings of biopsy specimens was useful for the differential diagnosis of PLE. Noninvasive VCE might be preferable and useful for screening and follow up of PLE without stricture. Prognosis of a subgroup of PLE was poor regardless of treatment.

Original languageEnglish
Pages (from-to)575-580
Number of pages6
JournalJournal of Clinical Gastroenterology
Volume46
Issue number7
DOIs
Publication statusPublished - 01-08-2012
Externally publishedYes

Fingerprint

Protein-Losing Enteropathies
Intestinal Lymphangiectasis
Double-Balloon Enteroscopy
Endoscopy
Ulcer
Digestive System Endoscopy
Amyloidosis
Colonoscopy
Small Intestine
Anti-Inflammatory Agents
Strongyloidiasis
Biopsy
Waldenstrom Macroglobulinemia
Polyarteritis Nodosa
Living Donors
Technetium
Serum Albumin
Crohn Disease
Radionuclide Imaging
Pharmaceutical Preparations

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Takenaka, H., Ohmiya, N., Hirooka, Y., Nakamura, M., Ohno, E., Miyahara, R., ... Goto, H. (2012). Endoscopic and imaging findings in protein-losing enteropathy. Journal of Clinical Gastroenterology, 46(7), 575-580. https://doi.org/10.1097/MCG.0b013e31823832ac
Takenaka, Hiroyuki ; Ohmiya, Naoki ; Hirooka, Yoshiki ; Nakamura, Masanao ; Ohno, Eizaburo ; Miyahara, Ryoji ; Kawashima, Hiroki ; Itoh, Akihiro ; Watanabe, Osamu ; Ando, Takafumi ; Goto, Hidemi. / Endoscopic and imaging findings in protein-losing enteropathy. In: Journal of Clinical Gastroenterology. 2012 ; Vol. 46, No. 7. pp. 575-580.
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author = "Hiroyuki Takenaka and Naoki Ohmiya and Yoshiki Hirooka and Masanao Nakamura and Eizaburo Ohno and Ryoji Miyahara and Hiroki Kawashima and Akihiro Itoh and Osamu Watanabe and Takafumi Ando and Hidemi Goto",
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Takenaka, H, Ohmiya, N, Hirooka, Y, Nakamura, M, Ohno, E, Miyahara, R, Kawashima, H, Itoh, A, Watanabe, O, Ando, T & Goto, H 2012, 'Endoscopic and imaging findings in protein-losing enteropathy', Journal of Clinical Gastroenterology, vol. 46, no. 7, pp. 575-580. https://doi.org/10.1097/MCG.0b013e31823832ac

Endoscopic and imaging findings in protein-losing enteropathy. / Takenaka, Hiroyuki; Ohmiya, Naoki; Hirooka, Yoshiki; Nakamura, Masanao; Ohno, Eizaburo; Miyahara, Ryoji; Kawashima, Hiroki; Itoh, Akihiro; Watanabe, Osamu; Ando, Takafumi; Goto, Hidemi.

In: Journal of Clinical Gastroenterology, Vol. 46, No. 7, 01.08.2012, p. 575-580.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Endoscopic and imaging findings in protein-losing enteropathy

AU - Takenaka, Hiroyuki

AU - Ohmiya, Naoki

AU - Hirooka, Yoshiki

AU - Nakamura, Masanao

AU - Ohno, Eizaburo

AU - Miyahara, Ryoji

AU - Kawashima, Hiroki

AU - Itoh, Akihiro

AU - Watanabe, Osamu

AU - Ando, Takafumi

AU - Goto, Hidemi

PY - 2012/8/1

Y1 - 2012/8/1

N2 - OBJECTIVES: Protein-losing enteropathy (PLE) is often difficult to diagnose. We evaluated the diagnostic yields of underlying diseases of PLE among esophagogastroduodenoscopy, colonoscopy, fluoroscopic conventional enteroclysis (FCE), videocapsule endoscopy (VCE), and double-balloon enteroscopy (DBE) and prognosis after treatment. METHODS: Between June 2003 and August 2010, 25 consecutive patients with PLE confirmed by fecal α1-antitrypsin clearance (n=18) and technetium 99m human serum albumin scintigraphy (n=19) were enrolled, investigated, and treated. RESULTS: Of 25 patients, 4 (16%) with intestinal lymphangiectasia secondary to macroglobulinemia (n=1), amyloidosis (n=2), and strongyloidiasis (n=1) were diagnosed at preceding esophagogastroduodenoscopy or colonoscopy, and 7 (32%) with primary intestinal lymphangiectasia and chronic nonspecific multiple ulcers unrelated to nonsteroidal anti-inflammatory drugs of the small intestine were newly diagnosed at FCE or VCE. Other 11 (44%) patients with primary intestinal lymphangiectasia, small-bowel tumors, amyloidosis, chronic nonspecific multiple ulcers unrelated to nonsteroidal anti-inflammatory drugs of the small intestine, Crohn's disease, and small-bowel ulcers due to polyarteritis nodosa were diagnosed only at DBE with biopsy. Three patients with primary intestinal lymphangiectasia, cirrhosis after living donor liver transplantation, and congestive heart failure were not diagnosed at any small-bowel examination. The overall diagnostic yield of FCE, VCE, and DBE was 62% (8/13), 83% (14/17), and 88% (22/25), respectively. Eight patients (32%) died of underlying disorders regardless of medical treatment over the follow-up period. CONCLUSIONS: DBE with pathologic findings of biopsy specimens was useful for the differential diagnosis of PLE. Noninvasive VCE might be preferable and useful for screening and follow up of PLE without stricture. Prognosis of a subgroup of PLE was poor regardless of treatment.

AB - OBJECTIVES: Protein-losing enteropathy (PLE) is often difficult to diagnose. We evaluated the diagnostic yields of underlying diseases of PLE among esophagogastroduodenoscopy, colonoscopy, fluoroscopic conventional enteroclysis (FCE), videocapsule endoscopy (VCE), and double-balloon enteroscopy (DBE) and prognosis after treatment. METHODS: Between June 2003 and August 2010, 25 consecutive patients with PLE confirmed by fecal α1-antitrypsin clearance (n=18) and technetium 99m human serum albumin scintigraphy (n=19) were enrolled, investigated, and treated. RESULTS: Of 25 patients, 4 (16%) with intestinal lymphangiectasia secondary to macroglobulinemia (n=1), amyloidosis (n=2), and strongyloidiasis (n=1) were diagnosed at preceding esophagogastroduodenoscopy or colonoscopy, and 7 (32%) with primary intestinal lymphangiectasia and chronic nonspecific multiple ulcers unrelated to nonsteroidal anti-inflammatory drugs of the small intestine were newly diagnosed at FCE or VCE. Other 11 (44%) patients with primary intestinal lymphangiectasia, small-bowel tumors, amyloidosis, chronic nonspecific multiple ulcers unrelated to nonsteroidal anti-inflammatory drugs of the small intestine, Crohn's disease, and small-bowel ulcers due to polyarteritis nodosa were diagnosed only at DBE with biopsy. Three patients with primary intestinal lymphangiectasia, cirrhosis after living donor liver transplantation, and congestive heart failure were not diagnosed at any small-bowel examination. The overall diagnostic yield of FCE, VCE, and DBE was 62% (8/13), 83% (14/17), and 88% (22/25), respectively. Eight patients (32%) died of underlying disorders regardless of medical treatment over the follow-up period. CONCLUSIONS: DBE with pathologic findings of biopsy specimens was useful for the differential diagnosis of PLE. Noninvasive VCE might be preferable and useful for screening and follow up of PLE without stricture. Prognosis of a subgroup of PLE was poor regardless of treatment.

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