Abstract
Intestinal lymphangiectasia (IL) is a rare disease requiring oral fat restriction. The aim of this study was to evaluate the efficacy of enteral nutrition compared to that of total parenteral nutrition (TPN). We retrospectively reviewed nine patients with IL presenting with protein-losing enteropathy. Of these, seven patients not responding to a low-fat diet were treated with elemental diet (ED), polymeric diet (PD) containing medium-chain triglycerides, or TPN. Improvement in serum total protein was observed in two of three on ED and in one of two on PD, compared with three of three on TPN. Enteric protein loss was improved in two of two on ED, one of two on PD, and two of two on TPN. Outpatients who continued to receive enteral nutrition maintained a total protein level. Enteral nutirition appears to be as effective as TPN for patients with IL, and it may provide a valid and safe alternative therapy.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Jeffries GH, Chapman A, Sleisenger MH: Low-fat diet in intestinal lymphangiectasia. Its effects on albumin metabolism. N Engl J Med 270:761–766, 1965
Yssing M, Jensen H, Jarnum S: Dietary treatment of protein-losing enteropathy. Acta Paediatr Scand 56:173–181, 1967
Alfano V, Tritto G, Alfonsi L, Cella A, Pasanisi F, Contaldo F: Stable reversal of pathologic signs of primitive intestinal lymphangiectasia with a hypolipidic, MCT-enriched diet. Nutrition 16:303–304, 2000
Amirhakimi GH, Samloff M, Bryson MF, Forbes GB: Intestinal lymphangiectasia. Metabolic studies. Am J Dis Child 117:178–185, 1969
Fleisher TA, Strober W, Muchmore AV, Broder S, Krawitt EL, Waldmann TA: Corticosteroid-responsive intestinal lymphangiectasia secondary to an inflammatory process. N Engl J Med 300:605–606, 1979
Rubin DC: Small intestine: anatomy and structural anomalies. Lymphangiectasia. In (ed) Textbook of Gastroenterology, 3rd ed. Yamada T, ed. Philadelphia, Lippincott Williams & Wilkins, 1999, pp 1578–1579
Vardy PA, Lebenthal E, Shwachman H: Intestinal lymphangiectasia: a reappraisal. Pediatrics 55:842–851, 1975
Goldberg RI, Calleja GA: Protein-losing gastroenteropathies. In Boccus Gastroenterology, 5th ed. Haubrich WS, Schaffner F, Berk JE (eds). Philadelphia, WB Saunders, 1995, pp 1072–1086
Aoyagi K, Iida M, Yao T, Matsui T, Okada M, Oh K, Fujishima M: Characteristic endoscopic features of intestinal lymphangiectasia: correlation with histological findings. Hepatogastroenterology 44:133–138, 1997
Aoyagi K, Iida M, Yao T, Matsui T, Okada M, Fujishima M: Intestinal lymphangiectasia: value of double-contrast radiographic study. Clin Radiol 49:814–819, 1994
Florent C, L’Hirondel C, Desmazures C, Aymes C, Bernier JJ: Intestinal clearance of alpha 1-antitrypsin. A sensitive method for the detection of protein-losing enteropathy. Gastroenterology. 81:777–780, 1981
Tsuchiya M, Oshio C, Asakura H, Ishii H, Aoki I, Miyairi M: Budd–Chiari syndrome associated with protein–losing enteropathy. Gastroenterology. 75:114–117, 1978
Edworthy SM, Fritzler MJ, Kelly JK, McHattie JD, Shaffer EA: Protein-losing enteropathy in systemic lupus erythematosus associated with intestinal lymphangiectasia. Am J Gastroenterol 85:1398–1402, 1990
Mistilis SP, Stephen DD, Skyring AP: Intestinal lymphangiectasia. Mechanism of enteric loss of plasma-protein and fat. Lancet 1:77–81, 1965
Giaffer MH, North G, Holdsworth CD: Controlled trial of polymeric versus elemental diet in treatment of active Crohn’s disease. Lancet. 335(8693):816–819, 1990
Verma S, Brown S, Kirkwood B, Giaffer MH: Polymeric versus elemental diet as primary treatment in active Crohn’s disease: a randomized, double-blind trial. Am J Gastroenterol. 95:735–739, 2000
Thompson JM, Brett A, Rose SJ: Dietary management of intestinal lymphangiectasia complicated by short gut syndrome. Hum Nut Appl Nutr 40:136–140, 1986
Rust C, Pratschke E, Hartl W, Kessler M, Weibecke B, Sauerbruch T, Paumgartner G, Beuers U: Fibrotic entrapment of the small bowel in congenital intestinal lymphangiectasia. Am J Gastroenterol 93:1980–1983, 1998
Mine K, Matsubayashi S, Nakai Y, Nakagawa T.: Intestinal lymphangiectasia markedly improved with antiplasmin therapy. Gastroenterology 96:1596–1599, 1989
Bac DJ, Van Hagen PM, Postema PT, ten Bokum AM, Zondervan PE, van Blankenstein M: Octreotide for protein–losing enteropathy with intestinal lymphangiectasia. Lancet 24(345):1639, 1995
Ballinger AB, Farthing MJ: Octreotide in the treatment of intestinal lymphangiectasia. Eur J Gastroenterol Hepatol 10:699–702, 1998
Kuroiwa G, Takayama T, Sato Y, Takahashi Y, Fujita T, Nobuoka A, Kukitsu T, Kato J, Sakamaki S, Niitsu Y: Primary intestinal lymphangiectasia successfully treated with octreotide. J Gastroenterol 36:129–132, 2001
MacLean JE, Cohen E, Weinstein M: Primary intestinal and thoracic lymphangiectasia: a response to antiplasmin therapy. Pediatrics 109:1177–1180, 2002
Tift WL, Lloyd JK: Intestinal lymphangiectasia. Long-term results with MCT diet. Arch Dis Child 50:269–276, 1975
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Aoyagi, K., Iida, M., Matsumoto, T. et al. Enteral Nutrition as a Primary Therapy for Intestinal Lymphangiectasia: Value of Elemental Diet and Polymeric Diet Compared with Total Parenteral Nutrition. Dig Dis Sci 50, 1467–1470 (2005). https://doi.org/10.1007/s10620-005-2863-7
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10620-005-2863-7