Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2018; 6(9): 284-290
Published online Sep 6, 2018. doi: 10.12998/wjcc.v6.i9.284
Case report and review of the literature of primary gastrointestinal amyloidosis diagnosed with enteroscopy and endoscopic ultrasonography
Yi-Pin Liu, Wei-Wei Jiang, Guo-Xun Chen, Yan-Qing Li
Yi-Pin Liu, Yan-Qing Li, Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
Yi-Pin Liu, Wei-Wei Jiang, Department of Gastroenterology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai 264100, Shandong Province, China
Guo-Xun Chen, Department of Nutrition, University of Tennessee, Knoxville, TN 37996, United States
Author contributions: Liu YP performed the endoscopy examinations and wrote the manuscript; Jiang WW participated in the patient management and followed up the patient after discharge; Chen GX was involved in the writing and responsible for language editing of the manuscript; Li YQ planned and gave guidance to the research.
Informed consent statement: Written informed consent was obtained from the individual participant included in the study.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yan-Qing Li, MD, PhD, Professor, Department of Gastroenterology, Qilu Hospital, Shandong University, 107 Wenhuaxi Road, Jinan 250012, Shandong Province, China. liyanqing@sdu.edu.cn
Telephone: +86-531-82166090 Fax: +86-531-82166090
Received: February 27, 2018
Peer-review started: February 27, 2018
First decision: March 30, 2018
Revised: June 27, 2018
Accepted: June 28, 2018
Article in press: June 28, 2018
Published online: September 6, 2018
Processing time: 192 Days and 16.2 Hours
ARTICLE HIGHLIGHTS
Case characteristics

A case with multiple nodular protuberances in the digestive tract with controllable moderate abdominal discomfort and anemia and a benign course.

Clinical diagnosis

After admission, a comprehensive physical examination demonstrated upper abdominal tenderness and moderate anemia.

Differential diagnosis

Theoretically, enteroscopy specifically covers the entire small intestine and extends the examination to the whole digestive tract and thus would improve the diagnosis of amyloidosis in the whole digestive tract, and endoscopic ultrasonography has unique characteristics that enable a diagnosis of amyloidosis of the digestive tract and reduces the rate of misdiagnosis.

Laboratory diagnosis

The laboratory tests showed low plasma levels of hemoglobin (84 g/L, normal range 110-150 g/L) and ferritin (1.2 ng/mL, normal range 10-291 ng/mL) and normal values for urine and stool routines at administration, and normal plasma levels of hemoglobin 124 g/L and 39.8 ng/mL without abnormalities for other routine parameters at three-year follow-up.

Imaging diagnosis

Transoral and transanal enteroscopy showed multiple nodular protuberances in the esophagus, ileum, colon and rectum, and endoscopic ultrasonography showed the nodular protuberances stemmed from the submucosa and partially invaded the intrinsic myometrium.

Pathological diagnosis

Pathological examinations found multiple small nodules in the submucosa and dyed structures.

Treatment

An oral iron supplement (Ferrous fumarate, 0.2 g/time, 3-4 times/d) were prescribed for one year for the anemia, along with medications such as esomeprazole magnesium (Nexium®), Talcid®, Domperidone for the treatment of abdominal discomfort.

Term explanation

Amyloidosis is categorized into primary, secondary and inheritable, and primary amyloidosis is the most common type.

Experiences and lessons

Primary gastrointestinal amyloidosis can be presented with controllable moderate abdominal discomfort and anemia and a benign course. Enteroscopy and endoscopic ultrasonography may play an important role in the diagnosis.