44. Protein-Losing Disorders of the Gastrointestinal Tract

  1. C. J. Hawkey FMedSci2,
  2. Jaime Bosch MD, PhD3,4,
  3. Joel E. Richter MD, FACP, MACG5,6,
  4. Guadalupe Garcia-Tsao MD7,8 and
  5. Francis K. L. Chan MD9
  1. Simon Murch PhD, FRCP, FRCPCH

Published Online: 16 APR 2012

DOI: 10.1002/9781118321386.ch44

Textbook of Clinical Gastroenterology and Hepatology, Second Edition

Textbook of Clinical Gastroenterology and Hepatology, Second Edition

How to Cite

Murch, S. (2012) Protein-Losing Disorders of the Gastrointestinal Tract, in Textbook of Clinical Gastroenterology and Hepatology, Second Edition (eds C. J. Hawkey, J. Bosch, J. E. Richter, G. Garcia-Tsao and F. K. L. Chan), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118321386.ch44

Editor Information

  1. 2

    Nottingham Digestive Diseases Centre, University of Nottingham and Nottingham University Hospitals, Nottingham, UK

  2. 3

    Hepatic Hemodynamic Laboratory, Liver Unit Hospital Clínic-IDIBAPS, University of Barcelona, Spain

  3. 4

    Biomedical Research Centre Network of Hepatic and Digestive Diseases (CIBERehd), National Institute of Health Carlos III Ministry of Science and Innovation Barcelona, Spain

  4. 5

    Division of Gastroenterology and Nutrition, University of South Florida Tampa, FL, USA

  5. 6

    Joy M. Culverhouse Center for Esophageal Diseases, University of South Florida Tampa, FL, USA

  6. 7

    Section of Digestive Diseases Yale University, School of Medicine New Haven, CT, USA

  7. 8

    Veterans Affairs Connecticut Healthcare System West Haven, CT, USA

  8. 9

    Department of Medicine & Therapeutics The Chinese University of Hong Kong, Hong Kong SAR, China

Author Information

  1. Division of Metabolic and Vascular Health, Warwick Medical School, The University of Warwick, Coventry, UK

Publication History

  1. Published Online: 16 APR 2012
  2. Published Print: 20 APR 2012

ISBN Information

Print ISBN: 9781405191821

Online ISBN: 9781118321386

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Keywords:

  • Protein-losing enteropathy;
  • Albumin;
  • Intestinal epithelium;
  • Heparan sulfate proteoglycans;
  • Glycosaminoglycans;
  • TNF-α;
  • Kwashiorkor

Summary

Excessive protein leakage from the gastrointestinal tract occurs in many disease states, and can be life-threatening. Recent clinical and experimental findings point to two major regulators of intestinal protein leakage – hydrostatic pressure within mesenteric lymphatics or venules, and epithelial barrier function. Barrier function is primarily provided by epithelial expression of anionic heparan sulfate proteoglycans, which retard albumin leakage. Both loss of proteoglycans and epithelial exposure to proinflammatory cytokines promotes transepithelial leakage. Treatment options may thus include reduction of excess mesenteric pressure, inhibition of mucosal inflammation and augmenting the charged epithelial barrier.