Gastrointestinal bleeding and amyloidosis

Although gastrointestinal bleeding is well known in patients with amyloidosis, when it occurs as the initial or sole overt manifestation of the disease it is much rarer and frequently causes diagnostic difficulty. This subject is reviewed in the context of a patient who underwent multiple invasive and noninvasive examinations to achieve this diagnosis. Both upper and lower gastrointestinal bleeding of all degrees has been shown to occur with amyloidosis. It appears that diffuse involvement of the gastrointestinal tract is much more common than a specific lesion. Our patient was ultimately found to have multiple waxy amyloid plaques and extremely friable jejunal mucosa at endoscopy. Radiographically, amyloidosis may cause diffuse thickening of the mucosal folds, a finding that carries a broad differential diagnosis. Arteriography, although not used frequently as a diagnostic modality in amyloidosis, may reveal luminal irregularities, truncation, and diffuse attenuation of the vasculature. The treatment of amyloidosis thus far has been unrewarding and difficult. Several new therapeutic measures which appear promising are discussed.