Alpha 1-antitrypsin, a reliable endogenous marker for intestinal protein loss and its application in patients with Crohn's disease.

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Abstract
Intestinal protein loss is generally determined by radiolabeled macromolecules. .alpha.1-Antitrypsin has been proposed as an endogenous marker for protein losing enteropathy, but different opinions exist about its reliability. In 25 patients with Crohn''s disease, fecal protein loss was studied with intestinal .alpha.1-antitrypsin (.alpha.1AT) clearance. Simultaneously, in 10 patients .alpha.1-AT clearance was compared with fecal 51Cr clearance after i.v. 51Cr-albumin injection. There was a linear relation (P < 0.05) between .alpha.1AT clearance and 51Cr clearnce in these cases. In all patients .alpha.1AT clearance was raised above control values. .alpha.1AT clearance, however, did not correlate with the activity index of Crohn''s disease. This index does not contain direct criteria of intestinal inflammation, does not take into account localization or extent of inflammation, and includes complications such as extraintestinal manifestations, fistuli, stenoses not necessarily related to actual mucosal involvement. .alpha.1AT is a reliable marker for intestinal protein loss and the intestinal changes of Crohn''s disease generally lead to an increased protein exudation into the gut.