The recent case report of intestinal lymphangiectasia(1) made interesting reading. I' would like to highlight some newer developments in protein losing enteropathy:

(a) Measurement of fecal alpha-l antitiypsin level by enzyme linked immunosorbent assay (ELISA) is now a well established modality for in vestigating suspected' protein losing enteropathy(2-4). This has simplified establishing enteric. protein loss which hitherto was considered difficult.

(b) Technetium (Tc 99) diethylene triamine pentaacetic acid human serum albumin scintigraphy and technetium (Tc 99) human serum albumin scintigraphy can detect the site of protein loss(5,6). In cases of localized intestinal lymph-angiectasia detected by scintigraphy, a surgical resection can be curative (Butzner JD, personal communication).

In the case described, as the child continues to have evidence of enteric protein loss (low serum albumin on follow up) and poor weight gain despite dietary, manipulation, it would be useful to perform scintigraphy which might identify a localized abnormality which. is amenable to a surgical resection.

Anupam Sibal,
Consultant Pediatric Gastroenterologist and Hepatologist,
Department of Multiorgan
Transplantation,
Indraprastha Apollo Hospital,
Delhi-Mathura Road,
New Delhi, India.
 

1.  Bhasker M, Moses PD. Intestinal lymphangiectasia. Indian Pediatr 1998; 35: 363-367.

2. Martinez Valverde A. Investigation of protein-Iosing enteropathy in pediatric patients. Anales Espanoles de Pediatria 1997; 47: 144-150.

3. Molina JF, Brown RF, Gedalia A, Espinoza LR. Protein losing enteropathy as the initial manifestation of childhood systemic lupus erythematosus. J Rheumatol 1996; 23: 269-1271.

4. Saitoh O, Matsumoto H, Sugimori K, Sugi K, Nakagawa K. Intestinal protein loss and bleeding assessed by fecal hemoglobin, transferrin, albumin and alpha-1 antitrypsin levels in patients with colorectal disease. Digestion 1995; 56: 67- 75.

5. Suzuki C, Higaki S, Nishaki M, Mitani N, Yanai H, Tada M, et al. 99m Tc-HSA - D scintigraphy in the diagnosis ,of protein losing gastroenteropathy due to secondary amyloidosis. J Gastroenterol 1997; 32: 78-82.

6. Lee BF, Huang YF, Yang CC, Jong SB, ,Chen UW, Liu FP, et al.Technetium - 99m albumin scintigraphy in the diagnosis of protein losing enteropathy: A case report. Kaohsiung J Med Sci 1995; 11: 366-370.