Intestinal
protein loss was measured by means of faecal
alpha 1-antitrypsin clearance (alpha 1 ATC) in patients with various
gastrointestinal diseases. In healthy controls and in patients with various
gastrointestinal diseases there is a remarkable intraindividual fluctuation of the faecal
protein loss from day to day. Alpha 1 AT clearance calculated from a three-day stool collection is usually sufficient to indicate enteric
protein loss in
Crohn's disease,
ulcerative colitis,
celiac sprue, and
Whipple's disease. However, in two patients with intermittent
diarrhea coinciding with
edema and hypalbuminemia excessive enteric
protein loss was observed on one day during a two week stool sampling period only. In one of these patients suction biopsies showed histologically intestinal lymphangiectasia of
a 10 cm segment of the upper jejunum. The alpha 1 ATC is a suitable and cheap method to determine enteric
protein loss without the use of
radioactive tracers and therefore can be used in clinics without departments of nuclear medicine. In contrast to the conventional Gordon test the use of the endogenous marker alpha 1 AT facilitates the determination of faecal
protein loss over long time periods, which might be of value in the diagnosis of intermittent occurring enteric
protein loss. Furthermore, the endogenous marker alpha 1 AT is of use in following the course of illness and in monitoring the efficacy of
therapy in patients with enteric
protein loss.