Published online Sep 6, 2018. doi: 10.12998/wjcc.v6.i9.284
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
A case with multiple nodular protuberances in the digestive tract with controllable moderate abdominal discomfort and anemia and a benign course.
After admission, a comprehensive physical examination demonstrated upper abdominal tenderness and moderate anemia.
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.
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.
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 examinations found multiple small nodules in the submucosa and dyed structures.
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.
Amyloidosis is categorized into primary, secondary and inheritable, and primary amyloidosis is the most common type.
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.