[Investigation of protein-losing enteropathy in pediatric patients].
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.


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.
Sierra Salinas
C
C
Unidad de Gastroenterología y Nutrición Infantil, Hospital Materno Infantil, Málaga.
Vicioso Recio
M I
MI
Barco Galvez
A
A
del Rio Mapelli
L
L
Martinez Valverde
A
A
D002648:Child; D002675:Child, Preschool; D005243:Feces / Q000737:chemistry; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D007223:Infant; D008297:Male; D011504:Protein-Losing Enteropathies / Q000150:complications / Q000175:diagnosis*; D000515:alpha 1-Antitrypsin / Q000032:analysis
D000515:alpha 1-Antitrypsin