title: Symptomatic primary (Al) amyloidosis of the stomach and duodenum.
abstract: Primary (AL) amyloidosis of the gastrointestinal tract is relatively rare, and symptomatic amyloidosis of the stomach is even more seldom. We present the case of a patient who was referred to upper endoscopy because of weight loss, nausea, and vomiting. Large areas of intramucosal hemorrhages were seen, and biopsies resulted in profuse bleeding stopped with endoscopic clips. The biopsies showed amyloid depositions and further workup revealed that the patient also had cardiac and neuropathic involvements. The patient started treatment with dexamethasone, melphalan and bortezomib. After treatment was started the nausea and epigastric discomfort improved, and a reduction in the biochemical markers troponin T, NT-proBNP, and M-component was observed. Gastric amyloidosis is rarely seen at upper endoscopy in patients without a previously established diagnosis, but the unusual endoscopic findings and bleeding tendency after biopsy should be kept in mind by gastroenterologists.
authors.affiliation: Department of Gastroenterology and Hepatology, St. Olavs Hospital, Prinsesse Kristinas Gate 1, 7006 Trondheim, Norway ; Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Prinsesse Kristinas Gate 1, 7489 Trondheim, Norway.
authors.forename: Reidar
authors.initials: R
authors.lastname: Fossmark
authors.forename: Espen
authors.initials: E
authors.lastname: Skarsvåg
authors.forename: Harald
authors.initials: H
authors.lastname: Aarset
authors.forename: Henrik
authors.initials: H
authors.lastname: Hjorth-Hansen
authors.forename: Helge L
authors.initials: HL
authors.lastname: Waldum