Intestinal amyloidosis: symptoms

Gastrointestinal tract in amyloidosis is affected all over. Macroglossia (a significant increase in 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. The amyloid is deposited along the course of the reticular stroma of the mucous membrane, in the walls of the vessels of the mucous membrane and submucosal layer, between the muscle fibers, along the nerve trunks and ganglia. Along with the delicate is affected and the large intestine. As a rule, simultaneously there are symptoms of amyloidosis of the kidneys, enlargement of the liver, spleen.

Amyloidosis of the intestine with predominant involvement of the thin section

The main manifestations of amyloidosis of the small intestine are:

• disorders of the stool (usually diarrhea or unstable stool - alternating constipation and diarrhea, much less often - constipation);
• abdominal pain of uncertain character, sometimes flatulence;
• malabsorption syndrome with violation of all kinds of metabolism;
• bleeding, perforation of the intestine 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 ulceration;
• development of mechanical or paralytic obstruction of the small intestine;
• steator, a large number of fatty acids in the feces.

It is possible to develop a local amyloidosis, with the amyloid deposited as a tumor and can be detected by palpation as a dense tumor-like conglomerate. This variant of amyloidosis can be manifested by pain in the projection of the small intestine, flatulence. The expressed syndrome of malabsorption, as a rule, does not happen.

Amyloidosis of the intestine with a predominant lesion of the colon

For this localization of amyloidosis, the following symptoms are characteristic:

• persistent constipation, it is possible to alternate constipation and diarrhea;
• pronounced bloating;
• pain in the abdomen (due to flatulence, spasms of the large intestine); usually the pain is localized in the projection of any part of the large intestine (for example, in the lateral abdomen, if the pain is caused by the predominant lesion of the ascending or descending colon, in the upper regions - with the defeat of the predominantly transverse colon, etc.);
• the development of partial or even complete intestinal obstruction, which is manifested by a sharp pain in the abdomen, pronounced meteorism, a violation of the escape of gases, the absence of stools, the appearance of vomiting, the increase in symptoms of intoxication. The appearance of intestinal obstruction is due to gut obturation with a significant deposition of amyloid masses. Often, the intestinal obstruction is paralytic, which is caused by a violation of the motor function of the intestine in connection with the development of amyloidosis;
• bleeding from the rectum, due to ischemia and ulceration of the intestinal mucosa.

In amyloidosis with a predominant lesion of the colon, the development of malabsorption syndrome is uncharacteristic in contrast to amyloidosis of the small intestine.

[1], [2], [3], [4], [5], [6]