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Intestinal Amyloidosis - Diagnosis

Alexey Kryvenko, medical expert
Last reviewed: 04.07.2025

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Diagnosis of intestinal amyloidosis

The following signs may help in diagnosing intestinal amyloidosis:

The presence of an underlying disease that leads to the development of intestinal amyloidosis (tuberculosis, bronchiectasis, rheumatoid arthritis, etc.).
Persistent diarrhea resistant to therapy with antibacterial, astringent, adsorbent and fixing agents (amyloidosis with predominant damage to the small intestine).
Clinical picture of malabsorption syndrome (characteristic of amyloidosis with predominant damage to the small intestine).
Presence of hepatomegaly and splenomegaly, macroglossia.
The presence of symptoms of kidney damage (edema, proteinuria, microhematuria).
Significant increase in ESR, increased blood levels of a2-globulins, fibrinogen, and beta-lipoproteins.
Positive complement fixation reaction with the patient's blood serum, using amyloid protein as an antigen.
Positive Bengold test (absorption of 60% or more of the congorot dye injected into the vein) and test with methylene blue.
Biopsy of the gums, rectal mucosa, jejunum and duodenum and detection of amyloid in biopsies. This is the most important and reliable diagnostic method.

Laboratory and instrumental data

Complete blood count. Iron deficiency hypochromic anemia may develop with severe malabsorption syndrome.
Coprological analysis. With the development of malabsorption syndrome, steatorrhea is observed, and creatorrhea and undigested pieces of food may be detected.
Biochemical blood test. Hyperglobulinemia is detected, often an increase in the content of a2 _- globulins. With the development of malabsorption syndrome, hypoproteinemia, hypocalcemia, sometimes a tendency to hypoglycemia, hyponatremia, hypocholesterolemia are detected.
A study of the absorption function of the small intestine reveals disturbances in the absorption of various substances (tests with galactose, D-xylose, etc.).
X-ray examination of the intestine. Characterized by prolonged retention of contrast agent in the intestine; gas accumulation; dilation of the small intestine (in paralytic obstruction); thickening and rigidity of the walls of the small intestine; point defects of the mucous membrane in the form of multiple barium spots with a diameter of 1-2 mm; narrowing of the lumen of the small intestine may be detected; sometimes atrophy of the mucous membrane is observed.
Laparoscopy. Ischemia of various segments of the small and large intestines, subserous hemorrhages, and thickening of the intestinal walls are determined.
Rectomanoscopy and colonoscopy. Rigidity of the wall, hemorrhages, ulcers, and sometimes polypoid growths are detected.
Histological examination of biopsies of the jejunum, duodenum, rectum, and gums. Biopsies reveal perivascular amyloid in the mucous membrane, submucous and muscular layers, and along the reticular and collagen fibers, as well as expansion and compaction of the villi.

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