Endoscopic features of primary amyloidosis of the stomach

Sawada, Takahiro; Adachi, Yasushi; Akino, Kozo; Arimura, Yoshiaki; Ishida, Tadao; Ishii, Yasuhisa; Endô, Tôru

doi:10.1055/s-0032-1309750

Cited by 15 publications

(16 citation statements)

References 5 publications

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“…A separate study, however, found no correlation between the type of amyloidosis and endoscopic findings [31]. In the stomach, findings can include submucosal tumor-like masses, erosions, ulcerations, intramural hematomas, and rugal thickening [32]. Amyloidomas have been reported on endoscopy or endoscopic ultrasound in the pancreas, stomach, and rectum [33-35].…”

Section: Reviewmentioning

confidence: 99%

Gastrointestinal Amyloidosis: Review of the Literature

Rowe¹,

Pankow²,

Nehme³

et al. 2017

Cureus

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Gastrointestinal amyloidosis (GIA), a protein deposition disorder, represents a complex common pathway that encompasses multiple etiologies and presentations. It represents a significant diagnostic and treatment challenge. The disease results from the deposition of insoluble extracellular protein fragments that have been rendered resistant to digestion. GIA can be acquired or genetic, and most commonly results from chronic inflammatory disorders (AA amyloidosis), hematologic malignancy (AL amyloidosis), and end-stage renal disease (Beta-2 amyloidosis). The deposition of these abnormal proteins interferes with gastrointestinal tract (GI) organ structure and function, most notably in the liver and small bowel. Presentation from GI involvement includes cirrhotic sequelae, abdominal pain, malabsorption, and GI bleeding. Diagnosis hinges on pathologic examination of affected tissue, with classic green birefringence under polarized light. Abdominal fat pad and rectal mucosal biopsy have been described as sites of higher sensitivity for diagnosis. Serum amyloid P scintigraphy is near 90% sensitive for diagnosis of AA amyloidosis. Patients should be considered for further evaluation to rule out additional organ involvement, notably cardiac and renal. Treatment hinges on an adequate suppression of the predisposing inflammatory disorder, or malignancy, followed by supportive therapy. Prognosis varies depending on the etiology of the disease, with the AL subtype showing worse outcomes, as well as those with hepatic involvement.

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Section: Reviewmentioning

confidence: 99%

Gastrointestinal Amyloidosis: Review of the Literature

Rowe¹,

Pankow²,

Nehme³

et al. 2017

Cureus

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“…2 The most common symptoms of GI amyloidosis are weight loss, diarrhea, malabsorption, pseudoobstruction, perforation and gastrointestinal bleeding, associated with vascular friability. 3,4 At endoscopy, GI amyloidosis can mimic many benign and malignant diseases, including ulcerative, flat or vegetant tumours. Only the histological examination allows the formulation of a correct diagnosis and a proper treatment, particularly in these solitary presentations.…”

Section: Discussionmentioning

confidence: 99%

Duodenal Amyloidotic Tumor

Jaconi¹,

Frego²,

Pagni³

2015

Gastro Open J

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“…This patient had large intramucosal hemorrhages and a polypoid lesion in the duodenum, where biopsies at upper endoscopy resulted in bleeding, but revealed amyloid deposits and led to the diagnosis of AL amyloidosis. Large hemorrhages requiring blood transfusion after biopsies from gastric amyloid lesions have been described by others [4] and may be related to small-vessel fragility due to amyloid infiltration and impaired hemostasis caused by factor X deficiency [7]. Bleeding diathesis has been observed in AL amyloidosis also under other circumstances and may cause purpura [8] and increase the risk of bleeding after liver biopsy [9].…”

Section: Discussionmentioning

confidence: 99%

“…Amyloidosis involving the gastrointestinal tract may cause symptoms related to altered motility, gastrointestinal bleeding, or malabsorption. In the stomach, gastric amyloidosis may have an endoscopic appearance mimicking gastric neoplasia [2, 3], hematomas, erosions and ulcerations, or a nodular gastritis [4]. The diagnosis of gastrointestinal amyloidosis may be hard to suspect in patients without previously diagnosed inflammatory or plasma cell disease.…”

Section: Introductionmentioning

confidence: 99%

Symptomatic Primary (AL) Amyloidosis of the Stomach and Duodenum

Fossmark

Skarsvåg

Aarset

et al. 2013

Case Reports in Gastrointestinal Medicine

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Primary (AL) amyloidosis of the gastrointestinal tract is relatively rare, and symptomatic amyloidosis of the stomach is even more seldom. We present the case of a patient who was referred to upper endoscopy because of weight loss, nausea, and vomiting. Large areas of intramucosal hemorrhages were seen, and biopsies resulted in profuse bleeding stopped with endoscopic clips. The biopsies showed amyloid depositions and further workup revealed that the patient also had cardiac and neuropathic involvements. The patient started treatment with dexamethasone, melphalan and bortezomib. After treatment was started the nausea and epigastric discomfort improved, and a reduction in the biochemical markers troponin T, NT-proBNP, and M-component was observed. Gastric amyloidosis is rarely seen at upper endoscopy in patients without a previously established diagnosis, but the unusual endoscopic findings and bleeding tendency after biopsy should be kept in mind by gastroenterologists.

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Endoscopic features of primary amyloidosis of the stomach

Cited by 15 publications

References 5 publications

Gastrointestinal Amyloidosis: Review of the Literature

Gastrointestinal Amyloidosis: Review of the Literature

Duodenal Amyloidotic Tumor

Symptomatic Primary (AL) Amyloidosis of the Stomach and Duodenum

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