Deposition of amyloid in the gastrointestinal tract.

Gilat, Tuvia; Revach, Moshe; Sohar, Ezra

doi:10.1136/gut.10.2.98

Cited by 136 publications

(56 citation statements)

References 37 publications

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“…Amyloid involvement of the gut can either be localized as nodules or the GI tract can be involved diffusely from the tongue to the anal orifice. 27,28 Amyloidosis can involve the submucosa, muscularis mucosa, and subserosa, as well as the vasculaBone Marrow Transplantation ture of the bowel. 28,29 Bleeding can arise from an ulcer in an area of localized amyloid deposition 16 or there might be diffuse oozing from the GI tract.…”

Section: Characteristicmentioning

confidence: 99%

“…27,28 Amyloidosis can involve the submucosa, muscularis mucosa, and subserosa, as well as the vasculaBone Marrow Transplantation ture of the bowel. 28,29 Bleeding can arise from an ulcer in an area of localized amyloid deposition 16 or there might be diffuse oozing from the GI tract. Vascular deposition of amyloid can potentially make the vessels friable and may explain the diffuse oozing commonly seen.…”

Section: Characteristicmentioning

confidence: 99%

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High incidence of gastrointestinal tract bleeding after autologous stem cell transplant for primary systemic amyloidosis

Kumar

Dispenzieri

Lacy

et al. 2001

Bone Marrow Transplant

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Summary:Peripheral blood stem cell transplants have been associated with better response rates than conventional chemotherapy in patients with primary systemic amyloidosis. A higher incidence of gastrointestinal (GI) tract bleeding has been observed among amyloidosis patients undergoing peripheral stem cell transplantation. We retrospectively reviewed the medical records of such patients to identify those who had GI tract bleeding in the post-transplant period. Forty-five patients were studied. Nine patients had GI tract bleeding in the posttransplant period. The median post-transplant duration to onset of bleeding was 9.5 days (range 1 to 48 days). Three patients had lower GI tract bleeding, two had upper GI tract bleeding, and four had both. Diffuse esophagitis and gastritis were the most common findings on endoscopy. There were no correlations among the age, platelet nadir, or CD34 count of the graft and the risk of bleeding. Women were more likely to have GI tract bleeding (P = 0.015), as were patients with slow platelet engraftment (P = 0.02). Patients with multiorgan involvement and those on hemodialysis appeared to be at a higher risk of GI tract bleeding. The mean posttransplant hospital stay for those with GI tract bleeding was 37 days compared with 14.5 days for those who did not have GI tract bleeding (P = 0.0047). Bone Marrow Transplantation (2001) 28, 381-385. Keywords: GI bleeding; high-dose chemotherapy; stem cell transplantation; systemic amyloidosis Primary systemic amyloidosis is a rare plasma cell proliferative disorder with an incidence of nearly eight per million per year. The prognosis for patients diagnosed with the disorder remains poor, with a median survival of only 13 months for those seen within 1 month of diagnosis.1 In those with congestive cardiac failure, the median survival is only 4 months, and only 5% survive more than 10 years. Currently available therapy has a minimal effect on the natural history of the disease and includes combination chemotherapy with melphalan and prednisone.2-4 Addition of other drugs, namely vincristine, BCNU, and cyclophosphamide to melphalan and prednisone (VBMCP), has not improved the results over melphalan and prednisone alone.

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Section: Characteristicmentioning

confidence: 99%

Section: Characteristicmentioning

confidence: 99%

High incidence of gastrointestinal tract bleeding after autologous stem cell transplant for primary systemic amyloidosis

Kumar

Dispenzieri

Lacy

et al. 2001

Bone Marrow Transplant

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“…In fact, an early study by Gilat and colleagues found GI tract involvement in 68 of 70 patients with systemic amyloidosis at autopsy and found the GI tract to be a sensitive location for diagnostic biopsy. 4 However, symptomatic GI tract involvement from systemic amyloidosis is very uncommon. Menke and colleagues reported that in 769 patients with primary systemic amyloidosis, only 8% of patients had GI involvement.…”

Section: Discussionmentioning

confidence: 99%

A rare gastrointestinal manifestation of systemic primary amyloidosis

Orr

Shelnut

Ergen

et al. 2016

Gastroenterol Insights

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Symptomatic gastrointestinal (GI) amyloidosis is a rare manifestation of systemic amyloid light chain amyloidosis. Further, the presentation of primary GI amyloidosis without previously diagnosed systemic amyloidosis is exceptionally rare. We describe a case of a patient presenting with abdominal pain, nausea, vomiting, and weight loss later to be diagnosed with localized GI amyloidosis from underlying multiple myeloma. Unfortunately, the GI disease was insurmountable leading to her death. Amyloidosis exerts its pathology at the level of the mucosa, soft tissue, nerves, and vascular supply of the GI tract. No specific treatments for the GI complications of amyloidosis are available and supportive measures are universally employed. GI amyloidosis is not only infrequently amenable to systemic and symptomatic treatment, but has a negative impact on both quality of life and survival.

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“…Amyloidosis of the stomach has been described as flat circular lesions with a fine granular appearance [24] , diffuse thickening of the gastric wall with a tendency to bleed [20,25] , irregularly-shaped, soft, mural tumors [21] , and even as a gastric ulcer with heaped up, friable edges, masquerading as malignancy [26] . In addition, loss of rugal folds and antral narrowing have been reported [27,28] .…”

Section: Discussionmentioning

confidence: 99%

Gastric amyloidoma in patient after remission of Non-Hodgkin’s Lymphoma

Koczka

Goodman

2009

WJGO

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Amyloidosis is commonly systemic, occasionally organlimited, and rarely a solitary localized mass. The latter, commonly referred to as tumoral amyloidosis, is described as occurring in nearly every organ/tissue. Only a few reports of gastric amyloidosis exist today. We describe a 72 year-old black male from Barbados presenting with 3 d of diffuse abdominal pain. His medical history included Non-Hodgkin's Lymphoma diagnosed five years ago, status-post six rounds of cyclophosphamide, adriamycin, vincristine, prednisone chemotherapy, and currently was in remission. On computed tomography scan of the abdomen, thickening and calcification of the gastric wall was noted along with pneumatosis. On esophagogastroduodenoscopy, a large circumferential friable mass was seen from the gastroesophageal junction to the body. A large nonbleeding 3 cm polyp was also seen in post bulbar area of duodenum. Biopsies were stained with Congo red and gave green birefringence under polarized light, consistent with tumoral amyloidosis. Positron emission tomography scan revealed diffuse gastric mucosa uptake compatible with gastric malignancy without metastatic foci. Treatment for gastric amyloidomas has presently been one of observation or, at most, resection of the amyloid mass. It is not known if our patient required the same approach or if this warranted the re-institution of chemotherapy for Non-Hodgkin's Lymphoma. Until more reports of tumoral amyloidosis are made known, treatment as well as prognosis remain uncertain.

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Deposition of amyloid in the gastrointestinal tract.

Cited by 136 publications

References 37 publications

High incidence of gastrointestinal tract bleeding after autologous stem cell transplant for primary systemic amyloidosis

High incidence of gastrointestinal tract bleeding after autologous stem cell transplant for primary systemic amyloidosis

A rare gastrointestinal manifestation of systemic primary amyloidosis

Gastric amyloidoma in patient after remission of Non-Hodgkin’s Lymphoma

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