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Random fecal alpha-1-antitrypsin concentration in children with gastrointestinal disease

  • Daniel W. Thomas
    Affiliations
    The Gastroenterology Program, Department of Pediatrics, Childrens Hospital of Los Angeles, Los Angeles, California, USA

    The University of Southern California School of Medicine, Los Angeles, California, USA
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  • Frank R. Sinatra
    Correspondence
    Address requests for reprints to: Frank R. Sinatra, M.D., Childrens Hospital of Los Angeles, 4650 Sunset Boulevard, Los Angeles, California 90027.
    Affiliations
    The Gastroenterology Program, Department of Pediatrics, Childrens Hospital of Los Angeles, Los Angeles, California, USA

    The University of Southern California School of Medicine, Los Angeles, California, USA
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  • Russell J. Merritt
    Affiliations
    The Gastroenterology Program, Department of Pediatrics, Childrens Hospital of Los Angeles, Los Angeles, California, USA

    The University of Southern California School of Medicine, Los Angeles, California, USA
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      Abstract

      Random fecal alpha-1-antitrypsin concentration was measured in children with various gastrointestinal diseases and in normal subjects. One hundred fifteen subjects were evaluated: controls (39); chronic inflammatory bowel disease (20); chronic diarrhea (18); acute gastroenteritis (17); allergic gastroenteropathy (5); chronic pancreatic exocrine insufficiency (4); acute gastrointestinal bleeding (4); nonspecific colitis (4); celiac disease (3); and intestinal lymphangiectasia (1). Mean fecal-alpha-1-antitrypsin for the controls was 0.98 mg/g lyophilized stool. All children with celiac disease, allergic gastroenteropathy, lymphangiectasia, nonspecific colitis, acute gastrointestinal bleeding, and 19 of 20 patients with active chronic inflammatory bowel disease had fecal alpha-1-antitrypsin concentrations >2.6 mg/g stool (mean of the controls + 2 SD). These disorders have all been previously documented to cause protein-losing enteropathy by 51Cr-labeled albumin excretion tests. The other study patients had normal fecal alpha-1-antitrypsin excretion when compared with controls. Serial fecal antitrypsin concentrations paralleled disease activity and clinical response to therapy. The results suggest that random fecal antitrypsin concentration is a valuable screening test for mucosal disorders associated with abnormal transmucosal serum protein loss.

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