Is portal hypertension associated with protein-losing enteropathy?
OBJECTIVE
Hypoalbuminemia in patients with decompensated cirrhosis has traditionally been assumed to be a result of to impaired liver synthesis; however, protein-losing enteropathy (PLE) may also contribute. The aim of this study was to assess whether hypoalbuminemic cirrhotic patients with portal hypertension had evidence of PLE.


METHODS
Sixteen patients with alcoholic cirrhosis, hypoalbuminemia and portal hypertension underwent whole gut lavage with polyethylene glycol solution. The effluent obtained was analyzed for albumin, immunoglobulin (Ig)G and alpha1-antitrypsin (alpha1-AT). Serum C-reactive protein (CRP) was also measured to assess the systemic inflammatory response.


RESULTS
Twelve of the 16 enrolled patients had a persistently low albumin concentration at the time of lavage. Only one patient (who was subsequently found to have celiac disease) had elevated concentrations of lavage albumin, alpha1-AT and IgG levels. There was a significant correlation between lavage albumin and alpha1-AT (r = 0.671, P = 0.024), and between lavage albumin and IgG (r = 0.614, P = 0.045). There was no correlation between serum albumin and lavage proteins. Six patients had elevated serum CRP levels, but serum albumin or lavage protein concentrations did not correlate with serum CRP.


CONCLUSIONS
There is no evidence of a significant PLE in patients with alcoholic cirrhosis, hypoalbuminemia and portal hypertension.
Georgopoulos
Philippos
P
Department of Gastroenterology and Surgery, Glasgow Royal Infirmary, Glasgow, UK. philgeor@panafonet.gr
Mowat
Craig
C
McMillan
Donald C
DC
Kingstone
Kathleen
K
Ghosh
Subrata
S
Stanley
Adrian J
AJ
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D034141:Hypoalbuminemia / Q000150:complications*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011504:Protein-Losing Enteropathies / Q000209:etiology*