Prevalence of digestive manifestations in patients with amyloidosis

ADELA AGUIRRE; MARIA LOURDES POSADAS MARTINEZ; ET AL

Congreso; The XVIth International Symposium on Amyloidosis: ISA2018; 2018

Prevalence of digestive manifestations in patients with amyloidosisMaría Belén Sánchez, María Dolores Matoso, María Adela Aguirre, Elsa Mercedes Nucifora, Sebastián Marciano, Jesica Cepeda, Santiago Rinaudo, Fernando Binder, María Lourdes Posadas Martinez, Bruno Rafael Boietti, Mariano MarcolongoDepartment of Medicine, Hospital Italiano de Buenos Aires, Grupo de Estudio de la Amiloidosis, Buenos Aires, Argentina,adela.aguirre@hospitalitaliano.org.arINTRODUCTION: Digestive manifestations are unspecific in patients with amyloidosis. Their presence may be underestimated and the impact on these patients quality of life is well known. There are few data reported about this topic. The aim of this presentation is to estimate the prevalence, type of digestive symptoms in adults with amyloidosis and their forms of presentation and to describe the endoscopic and pathologic findings.MATERIALS & METHODS: We perform a cross-sectional study including adult patients from the Institutional Registry of Amyloidosis at Hospital Italiano de Buenos Aires, Argentina. Digestive manifestations, endoscopic, and anatomopathological findings were recorded. The categorical variables are presented with their absolute and relative value (percentages) and the continuous variables as medians with their interquartile intervals, according to their distribution.RESULTS: We analyzed 138 patients with amyloidosis, 84 (60.8%) were men, with a median age of 65 years (ICR 51-73). The proportion of different subtypes of amyloidosis was: AL 43.4%, ATTRwt 16.6%, Localized 14.4%, AA 10.1%, undefined 8.6%, TTR 6.5%. The prevalence of digestive manifestations was 68 (49.2%), being the most frequent: chronic diarrhea (36.6%), constipation (29.4%), dyspepsia (22%) and evident bleeding (20.6%). Out of 138 patients, 46 (33.3%) had performed esophagogastroduodenoscopy. In 34 of them (73.9%), findings were linked to infiltration and to neuropathic involvement, other were non-specific. The most frequent findings were: esophagitis, erosive gastropathy, gastric evacuation delay, congestion and friability of the mucosa. Out of 138 patients with amyloidosis 51 (36.9%) underwent videocolonoscopy and 30 (58.8%) presented abnormal findings. Among the most frequent, although of an unspecified nature, are polyps and diverticula, followed by compatible lesions, ischemic colitis, congestion with diffuse friability of the mucosa and rectal ulcers. Biopsies were performed in 32 patients (23.2%) and at least one Congo Red (CR) organ was positive in 14 (43.7%). The organ with the highest proportion of positive CR samples was the duodenum (9 of 20 patients biopsied, 45%), followed by colon-rectum (6/16, 37.5%) and stomach (7/20, 35%).DISCUSSION & CONCLUSIONS: This is the first report in our country on the prevalence of digestive symptoms in patients with amyloidosis. The prevalence of such events was high and the most frequently encountered were diarrhea, constipation, dyspepsia and gastrointestinal bleeding, which is consistent with data reported in the literature. The organ that presented a the highest proportion of CR positive biopsies was duodenum, followed by colon-rectum and stomach.