From the Research
Increased fecal alpha-1 antitrypsin (A1AT) clearance can occur due to several conditions beyond protein-losing enteropathies, including inflammatory bowel diseases, intestinal infections, celiac disease, lymphatic obstruction, vasculitis, radiation enteritis, and certain medications, as supported by studies such as 1 and 2.
Conditions Causing Increased Fecal A1AT Clearance
- Inflammatory bowel diseases like Crohn's disease and ulcerative colitis, where intestinal inflammation causes protein leakage into the gut lumen
- Intestinal infections, particularly those causing significant mucosal damage such as bacterial overgrowth, parasitic infections (like giardiasis), and certain viral enteritides
- Celiac disease, through villous atrophy and compromised intestinal barrier function, contributes to elevated A1AT clearance, with a link between celiac disease and small intestinal bacterial overgrowth suggested by 1
- Lymphatic obstruction conditions, including intestinal lymphangiectasia and lymphoma, impair protein reabsorption
- Vasculitis affecting intestinal vessels, radiation enteritis, and certain medications (particularly NSAIDs and chemotherapeutic agents) that damage intestinal mucosa can increase fecal A1AT
- Gastrointestinal malignancies may disrupt normal mucosal barriers
- Congestive heart failure and portal hypertension can cause passive congestion leading to protein leakage
- Amyloidosis affecting the gastrointestinal tract can also increase A1AT clearance through direct tissue damage
Diagnostic Considerations
The diagnosis of increased fecal A1AT clearance should consider these conditions, especially when protein-losing enteropathy is suspected but the primary cause remains unclear, as discussed in 3 and 2.
Treatment Implications
Treatment of increased fecal A1AT clearance targets the underlying disease, with antimicrobial therapy showing promise in improving gastrointestinal symptoms in SIBO-positive celiac disease patients, as reported in 1.