PLE, CIL and the Diagnostic Process

The terms we use to describe this disease can be very confusing.  I want to try to use this post to clarify the terms PLE and CIL, and help you understand why your vet might have used both of these terms in making a diagnosis.

When your vet is doing the initial workups to try to figure out what’s going on with your dog, she usually will do some bloodwork.  When the bloodwork is run they’ll notice that the protein levels are low.  At this point, and depending on how low it is by this point, they’ll probably start suspecting a protein-losing disease of some sort.

Protein can be lost through the kidneys or the intestine and the blood test doesn’t tell them which, so now they need to narrow that down.  They’ll run more tests and/or make preliminary diagnoses based on other symptoms.  Once they determine that the protein is being lost through the intestines, they’ll make a diagnosis of PLE, which literally stands for “protein-losing enteropathy.”  What that diagnosis and phrase means is “protein loss from the intestine.”  Now we know where the protein is being lost from; we know what part of the body is diseased.  But it’s not the whole story.

At this point, they still have to figure out which *form* of PLE it is in order to know how to treat it, because there are several different ways the intestines can lose protein, and the different ways have different treatments. That’s when they start looking at the intestines via ultrasound to see what kind of masses or abnormalities are in there and, after this, they’ll perhaps suggest you do an endoscopy with biopsy to determine if the lymphatic cells are diseased or if other problems are present.  At this point they are looking to see if your dog has lymphoma, CIL, IBD or some other protein-losing disease.

Once this round of testing is complete they will refine the diagnosis to CIL and/or or some other intestinal disease.  And here is, I think, where it gets confusing.  You get the diagnosis of PLE first, and then when they narrow it down you get a more refined diagnosis of CIL (and maybe also IBD) that basically tells you what kind of PLE it is.  It’s this second diagnosis that tells your vet what your treatment options are.

Ultimately we end up with two diagnoses that describe the same disease.  You can more easily understand this if you think about having a diagnosis of cancer.  Your doctor might say, “you have cancer” but she might need to do more testing to determine where, in the body, the cancer resides, or exactly what form it takes.  So you have an initial diagnosis of “cancer,” but a later, more refined diagnosis of “non-Hodgkins lymphoma.”  The relationship between the terms PLE and CIL is very much the same.

I hope this clears up some of the confusion around these terms.



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