What are Protein-losing Enteropathies?

According to Albert Jergens, DVM, MS, PhD, DACVIM (SAIM), professor at the Iowa State University College of Veterinary Medicine, “Protein-losing enteropathies really describe kind of a clinical syndrome, not necessary disease, because they can be caused by too broad classification of diseases.

Mucosal inflammation, again, things like inflammatory bowel disease, neoplasia, systemic mycoses. The other big category would be intestinal lymphangiectasia. Now intestinal lymphangiectasia has many instances idiopathic, we don't know what causes it likely some breed predispositions in certain breeds, maybe Yorkshire Terriers as well as other breeds. And the principles with protein-losing enteropathies is, these animals likely fail to respond to our routine impaired therapies. So, they don't get better with elimination diets per se, they may not get better with treatments from inflammatory disease. So, we need a specific diagnosis, because that animal that has inflammatory bowel disease is going to be treated very differently versus that animal that has cancer, or that animal that has an infectious cause.

Treatment strategies for protein-losing enteropathies are probably multifactorial. And so, biopsy either endoscopic or surgery allows us to confirm the diagnosis, and then we use a variety of dietary treatments, in general, diets that are somewhat or moderately reduced in fat are thought to be beneficial. I think diets using a hydrolyzed protein source such as hydrolyzed soy or chicken also work well. Many of these animals on biopsies have low grades or moderate grades of intestinal inflammation, and so there's a little bit of a controversy should we treat that concurrent inflammation that we see microscopically? In general, I do.

And so, treatment strategies principally are dietary, and pharmacologic, and management kind of in that sequential order. Also, we need to be aware of potential complications such as thromboembolism, and so, drugs that reduce platelet interactions such as aspirin or clopidogrel plavix, also should be advocated in these patients.”