Een ongebruikelijke oorzaak van een hoge digestieve bloeding: amyloïdose van de maag

An unusual cause of major upper digestive bleeding: gastric amyloidosis Amyloidosis is a systemic disease that may target the gastrointestinal tract. The disease is caused by the extracellular tissue deposition of fibrils composed of low-molecular weight subunits of a variety of proteins. Amyloidosis may encompass multiple presentations and symptoms, being a challenge for both the diagnosis and the treatment. Gastrointestinal amyloidosis can cause bleeding, malabsorption, protein-losing enteropathy and dysmotility. The authors describe the case of a 71-year-old patient with persisting epigastric discomfort. The initial gastroscopy revealed ulcerative gastritis. Biopsies turned out to be Helicobacter pylori negative. There were no signs of malignancy either. An additional gastroscopy because of discomfort confirmed ulcerative gastritis. Anatomopathological examination of new biopsies revealed amyloidosis of the stomach. Additional examinations (including an echocardiography, a PET CT scan and a colonoscopy with rectal biopsies and Congored staining) did not confirm other organs to be involved in the amyloidosis. The patient was readmitted later because of a major upper digestive bleeding due to persisting gastric ulcerations. A partial distal gastrectomy turned out to be inevitable. Anatomopathological examination of the stomach confirmed non-AA amyloidosis of the stomach. Additionally, a short overview of amyloidosis with special attention to the impact of the disease in the gastrointestinal tractus is presented.