P2472 - Gastrointestinal Amyloidosis Preferentially Affects the Small Bowel in Subjects That Have Both Dysmotility and Gastrointestinal Bleed: A Systematic Review

Saad Saadat, MD¹, Shehr Asghar, MS², AbdiGhani Ismail, MD¹, Satya Kurada, MD^1
1Indiana University School of Medicine, Indianapolis, IN; ²Marion University College of Osteopathic Medicine, Indianapolis, IN

Introduction: Gastrointestinal amyloidosis is characterized by protein deposition throughout the gut. This review aims to investigate the presentation and outcomes of subjects who have gastrointestinal dysmotility and bleeding from amyloidosis.

Methods: A comprehensive search of PubMed, Cochrane Library, and Embase was performed from inception to June 2024 in order to identify all studies that included subjects with amyloidosis presenting with gastrointestinal dysmotility (GID) and gastrointestinal bleeding (GIB) of any kind (Figure 1a). Two independent reviewers extracted data, and disagreements were resolved by a third author.

Results: Among 125 studies identified on initial search, 37 were identified for full-text review, and 17 were eligible for inclusion. There was a total of 44 subjects that were included in this review (Figure 1b). 50% of subjects were male. The average age was 62.1 years old. 18 (47.4%) subjects had partial or pseudo-obstruction, 4 (10.6%) had gastric outlet obstruction, and 16 (42.1%) had unspecified ileus. Seven (58.3%) subjects were found to have bleeding ulcers, 2 (16.7%) had gastritis, and 3 (25.0%) had other unspecified bleeding lesions. The most common site of bleeding was the small bowel with 14 subjects (70.0%), including 5 (25.0%) in the duodenum and 2 (10.0%) in the terminal ileum. Thirteen (59.1%) had AL amyloidosis and 9 (40.9%) subjects had AA amyloidosis (Table 1). The most common identified etiology of amyloidosis was multiple myeloma with 5 (62.5%) subjects. Four (18.2%) subjects had evidence of systemic disease. One subject had undergone evaluation for bone marrow transplant, 1 received IV steroids, and 1 was initiated on chemotherapy. Those on chemotherapy and IV steroids had an improvement in GID and GIB. Four subjects had undergone abdominal surgery with 2 of them undergoing bowel resection for bleeding or obstruction. Of the 5 subjects of which there is follow-up data 3 had died.

Discussion: Our review is the first that investigates the overlap of GIB and GID in amyloidosis. The small bowel appears to be preferentially affected as this was the site with the most bleeding and point of pseudo-obstruction or ileus. The need for bowel resection depends on the etiology of dysmotility and bleeding. Further studies should be done to investigate the characteristics that may predict GIB and GID in subjects with gastrointestinal amyloidosis.



Disclosures:


Saad Saadat, MD¹, Shehr Asghar, MS², AbdiGhani Ismail, MD¹, Satya Kurada, MD¹. P2472 - Gastrointestinal Amyloidosis Preferentially Affects the Small Bowel in Subjects That Have Both Dysmotility and Gastrointestinal Bleed: A Systematic Review, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.