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Intestinal Amyloidosis - Symptoms
Last reviewed: 04.07.2025
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The gastrointestinal tract is affected throughout its entire length in amyloidosis. Macroglossia (significant enlargement of the tongue) is observed in 20-22% of patients, hepatomegaly and splenomegaly - in 50-80% of patients, the esophagus may be affected, sometimes there is a tumor-like lesion of the stomach.
However, amyloidosis of the small intestine is most pronounced. Amyloid is deposited along the reticular stroma of the mucous membrane, in the walls of the vessels of the mucous membrane and submucous layer, between muscle fibers, along the nerve trunks and ganglia. Along with the small intestine, the large intestine is also affected. As a rule, there are symptoms of renal amyloidosis, enlargement of the liver and spleen.
Intestinal amyloidosis with predominant involvement of the small intestine
The main manifestations of small intestinal amyloidosis are:
- bowel disorders (usually diarrhea or unstable stool - alternating constipation and diarrhea, much less often - constipation);
- abdominal pain of an unspecified nature, sometimes flatulence;
- malabsorption syndrome with disturbance of all types of metabolism;
- bleeding, intestinal perforation with the development of peritonitis, which is associated with the deposition of amyloid in the intestinal vessels; this causes circulatory disorders in the intestinal wall, the development of ulcers;
- development of mechanical or paralytic obstruction of the small intestine;
- steatorium, a large amount of fatty acids in the feces.
Local amyloidosis may develop, in which case the amyloid is deposited as a tumor and can be detected by palpation as a dense tumor-like conglomerate. This variant of amyloidosis may manifest itself as pain in the projection of the small intestine, flatulence. As a rule, there is no pronounced malabsorption syndrome.
Intestinal amyloidosis with predominant colonic involvement
The following signs are characteristic of this localization of amyloidosis:
- persistent constipation, possibly alternating constipation and diarrhea;
- severe abdominal distension;
- abdominal pain (caused by flatulence, spasms of the large intestine); usually the pain is localized in the projection of some section of the large intestine (for example, in the lateral part of the abdomen, if the pain is caused primarily by damage to the ascending or descending colon; in the upper sections - if the damage is primarily to the transverse colon, etc.);
- development of partial or even complete intestinal obstruction, which is manifested by severe abdominal pain, severe flatulence, impaired gas passage, lack of stool, vomiting, and increasing symptoms of intoxication. The appearance of intestinal obstruction is caused by intestinal obstruction by significant deposition of amyloid masses. Quite often, intestinal obstruction is paralytic in nature, which is caused by impaired intestinal motor function due to the development of amyloidosis;
- bleeding from the rectum caused by ischemia and ulceration of the intestinal mucosa.
In amyloidosis with predominant damage to the colon, the development of malabsorption syndrome is not typical, unlike amyloidosis of the small intestine.
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