Protein-Losing Enteropathy

There are three main types of cause. First, diseases with damage to the gut lining, such as Crohn's disease, coeliac disease, infections, or some infections of the bowel and medicines. Second, problems with the lymphatic vessels (the small channels that drain fluid and fat from the gut), such as intestinal lymphangiectasia (widened lymph vessels), lymphoma, and obstruction after certain heart operations or in heart failure. Third, conditions with increased pressure in veins, as in heart failure or constrictive pericarditis. Finding the cause is the main aim of the assessment.

It is uncommon. It can occur at any age, including in children, and is usually a complication of another condition in the gut, the lymphatic system or the heart.

Blood tests show low albumin and may show low antibodies, calcium, vitamins or lymphocytes (a type of white blood cell). Kidney and liver conditions, which are more common causes of low albumin, are checked first through blood and urine tests. PLE is confirmed with a stool test that measures a protein called alpha-1 antitrypsin, or, in some centres, with a nuclear scan. Then the cause is looked for using endoscopy and colonoscopy with biopsies, capsule endoscopy, CT or MR imaging, and heart tests. The doctor decides which are needed.

Treatment focuses on the cause, but certain steps help with symptoms.

• Keep all appointments and blood tests, which show how protein levels are changing

• Weigh yourself regularly and note swelling, as your team advises

• Rest legs raised when seated to ease swelling, and walk regularly to lower the risk of clots

• Wash hands and avoid contact with people who are unwell, as you may be more prone to infection

• Do not take water tablets or salt substitutes unless prescribed

Nutrition is a key part of treatment and should be guided by a dietitian, because the right diet depends on the cause.

• Eat enough calories and a high-protein diet unless your doctor advises otherwise

• If the cause is a lymphatic problem, a low-fat diet with medium-chain triglyceride (MCT) oil (a type of fat that is absorbed without the lymphatic system) is often used

• Limit salt to help reduce swelling if advised

• Supplements of vitamins A, D, E, K, calcium and other minerals may be needed; take only what is prescribed

• Do not start restrictive or fad diets without your dietitian

Medicines treat the cause and the complications. Your doctor decides what you need.

• Anti-inflammatory or immune-modifying medicines for inflammatory bowel disease or related conditions

• Treatment of infection, coeliac disease (through a gluten-free diet) or other identified cause

• Treatment of heart conditions if they are the cause

• Diuretics (water tablets) or albumin infusions in selected people, in hospital or under close supervision

• Immunoglobulin replacement or blood-clot preventing medicines in selected situations

Procedures mostly help find the cause, and treat it in specific situations.

• Upper endoscopy and colonoscopy with biopsies

• Capsule endoscopy or enteroscopy to look at the small bowel

• CT, MRI, lymphatic imaging or echocardiography as needed

• Surgery or specialist procedures to treat a localised cause, such as a diseased bowel segment or heart or lymphatic problem, in selected people

Because PLE has many causes, specialist care often involves gastroenterologists, dietitians, heart specialists and others. In lymphatic causes, a special diet that limits some fats and uses a particular type of fat is a mainstay; in inflammatory causes, treating the inflammation can reverse the protein loss.

The outlook depends on the underlying cause. When the cause can be treated, such as inflammation or infection, protein levels often recover. Where it is a long-term condition, such as lymphatic problems, it is usually manageable with diet, medicines and monitoring, though it may need long-term follow-up. Early assessment reduces complications such as infections, blood clots and malnutrition.

• What is causing the protein loss in my case?

• Which tests do I still need?

• What diet should I follow, and can I see a dietitian?

• How will you monitor my protein level and my risk of infections and clots?

• Is this likely to improve or will I need long-term treatment?

This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the Approved for publication by SGA; individual clinician review is ongoing. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.