Key result
Complete pericardiectomy frequently reverses protein-losing enteropathy in constrictive pericarditis.
Why the study?
Constrictive pericarditis very rarely causes protein-losing enteropathy induced by secondary intestinal lymphangiectasia, and the literature was reviewed to clarify its clinical management.
This review highlights that protein-losing enteropathy is a rare complication of constrictive pericarditis that can often be reversed with complete pericardiectomy.
Pericardiectomy may reverse protein-losing enteropathy in constrictive pericarditis; leaves open need for prospective validation before practice change.
Background/Objectives: Constrictive pericarditis very rarely causes protein-losing enteropathy (PLE) induced by secondary intestinal lymphangiectasia. This study thoroughly reviewed the literature to shed light on the clinical management of PLE provoked by intestinal lymphangiectasia following constrictive pericarditis. Methods: We performed a PubMed search using the keywords enteropathy, protein-losing enteropathy, pericarditis, acute pericarditis, pericardial effusion, recurrent pericarditis, constrictive pericarditis, noninfectious pericarditis, idiopathic pericarditis, and infective pericarditis, with only English-language publications included. Results: Although constrictive pericarditis is primarily idiopathic, less common causes include infectious etiologies, connective/autoimmune tissue disorders, previous cardiac surgery, congenital syndromes, and cancer. On the one hand, PLE secondary to intestinal lymphangiectasia may cause a severe cellular immune deficiency that could raise infection hazards due to lymphocytopenia and hypogammaglobulinemia. On the other hand, lymphocytopenia may cause anergy and mask an underlying tuberculous etiology of constrictive pericarditis. Cardiac catheterization is the most useful diagnostic tool for constrictive pericarditis, though it may be misdiagnosed in rare cases. The videocapsule endoscopy and double-balloon enteroscopy techniques can detect small bowel lymphangiectasias distal to the Treitz ligament. MRI or a CT scan helps confirm constrictive pericarditis, visualize lymphangiectasias, and reveal features specific to the underlying etiology of PLE. Radioisotopic techniques may ensure PLE diagnosis in challenging cases, whereas fecal alpha1-antitrypsin can estimate gastrointestinal protein loss. Conclusions: Constrictive pericarditis is rarely associated with PLE. The cardio-intestinal abnormalities of PLE caused by constrictive pericarditis are frequently reversed following a complete pericardiectomy, though its ability to invert severe hypoalbuminemia is currently unknown.
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Birtolo et al. (2024) conducted a review in Constrictive pericarditis and protein-losing enteropathy. Constrictive pericarditis was evaluated. Constrictive pericarditis is rarely associated with protein-losing enteropathy, and cardio-intestinal abnormalities are frequently reversed following complete pericardiectomy.