Severe protein losing enteropathy with intractable diarrhea due to systemic AA amyloidosis, successfully treated with corticosteroid and octreotide

Fushimi, Tomohisa; Takahashi, Yasuhumi; Kashima, Yuichiro; Fukushima, Kazuhiro; Ishii, Wataru; Kaneko, Kazuma; Yazaki, Masahide; Nakamura, Akinori; Tokuda, Takahiko; Matsuda, Masayuki; Furuya, Ryo; Ikeda, Shu‐ichi

doi:10.1080/13506120500032725

Cited by 52 publications

(30 citation statements)

References 17 publications

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“…Octreotide has earlier been shown to alleviate various types of diarrhea due to infections, drug-induced conditions, radiation and endocrine tumors [1][2][3][4]. It has also been used as a "hormonal temporary ileostomy" in connection with colectomy [5].…”

Section: Discussionmentioning

confidence: 99%

“…Octreotide reduces the output of the exocrine pancreas; it is useful in the treatment of intestinal fistulae and can be used as leak prophylaxis in pancreatic surgery. Moreover, octreotide has successfully been used in patients with problematic diarrhea, resistant to conventional medication and of various etiology [1][2][3][4]. Patients with a high-output ileostomy benefit from octreotide medication.…”

Section: R Gullichsenmentioning

confidence: 99%

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Long-acting octreotide in the treatment of diarrhea after pelvic pouch surgery

Gullichsen

2006

Tech Coloproctol

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After pelvic pouch surgery (restorative proctocolectomy), periodic or continuous diarrhea is common. Distressing diarrhea may be triggered by pouchitis, cuffitis or an anastomotic stricture. Medical therapy with loperamide or diphenoxylate is often unsatisfactory even after the correction of the underlying problem. Seven patients, who earlier had undergone restorative proctocolectomy, were treated with a standard dose of 10 mg of long-acting octreotide (Sandostatin LAR) for prolonged and distressing diarrhea which had not responded to conventional medication. Five of the patients had complete relief of diarrhea. The effect lasted for at least two months after a single dose. Two patients did not respond. No sideeffects were reported. Long-acting octreotide is effective in the treatment of severe diarrhea in patients after pelvic pouch surgery.

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Section: Discussionmentioning

confidence: 99%

Section: R Gullichsenmentioning

confidence: 99%

Long-acting octreotide in the treatment of diarrhea after pelvic pouch surgery

Gullichsen

2006

Tech Coloproctol

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“…Other agents that have been added to corticosteroids are octreotide [67] or anti-TNF agents [74]. Three-quarters of the deaths are thought to be directly due to amyloidosis, usually from renal disease [66].…”

Section: Amyloidosismentioning

confidence: 99%

“…Clinical GI symptoms are present in 22% of patients with secondary amyloidosis; whether this is due to a motility problem or to direct deposition of amyloid in the mucosa is unknown. Patients may present with intractable diarrhea, malabsorption, abdominal pain, nausea, and protein-losing enteropathy [66][67][68]. In patients with malabsorption, the amyloid is located perivascularly in the lamina propria and submucosa with normal villous structure [69].…”

Section: Amyloidosismentioning

confidence: 99%

Gastrointestinal and Hepatic Manifestations of Rheumatoid Arthritis

Ebert

Hagspiel

2011

Dig Dis Sci

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Rheumatoid arthritis (RA), characterized by inflammation of the synovium and surrounding structures, has a prevalence of 0.5-1%. Rheumatoid vasculitis (RV) is an inflammatory condition of the small- and medium-sized vessels that affects up to 5% of patients with RA with intestinal involvement in 10-38% of these cases. Clinically apparent RV of the gastrointestinal (GI) tract, while rare, is often catastrophic, resulting in ischemic ulcers and bowel infarction. Vasculitis of the colon may present as pancolitis clinically similar to ulcerative colitis. Rectal biopsies that include submucosal vessels are positive for vasculitis in up to 40% of cases. Abnormal esophageal motility in RA may result in heartburn and dysphagia. Chronic atrophic gastritis may be associated with hypergastrinemia and hypo- or achlorhydria, promoting small bowel bacterial overgrowth. RA is the most common cause of secondary amyloidosis with GI symptoms in 22% of affected patients. Although amyloid is usually found in the liver, it is rarely evident clinically. Felty's syndrome occurs in less than 1% of patients with RA and is characterized by neutropenia and splenomegaly. The liver may be involved with portal fibrosis or nodular regenerative hyperplasia. Liver histology is abnormal in 92% of RA patients at autopsy, although the changes are usually mild without associated hepatomegaly. Drug-induced liver disease may occur with aspirin, sulfasalazine, and methotrexate. Significant liver damage is rare if the drug is discontinued or the patient is properly monitored. RA can affect both the GI tract and the liver; changes are usually mild except with RV.

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“…In remarkable protein losing enteropathy with intractable diarrhea due to AA amyloidosis, a successful treatment that combines somatostatin analogue octreotide and corticosteroids has been reported [80,81].…”

Section: Therapymentioning

confidence: 99%

Clinical strategies for amyloid A amyloidosis secondary to rheumatoid arthritis

Nakamura

2008

Mod Rheumatol

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Secondary amyloid A (AA) amyloidosis is an important complication of rheumatoid arthritis (RA) and has remarkable variation in frequency worldwide. It is a serious, potentially life-threatening disorder caused by deposition in organs of AA fibrils, which are derived from the circulatory, acute-phase-reactant, serum amyloid A protein (SAA). The SAA1.3 allele can serve not only as a risk factor for the association of AA amyloidosis but also as a poor prognostic factor in Japanese RA patients. Both the association of AA amyloidosis arising early in RA disease course and symptomatic variety and severity were found in amyloidotic patients carrying the SAA1.3 allele. Etanercept for patients with AA amyloidosis who carry the SAA1.3 allele showed the amelioration of rheumatoid inflammation, including marked reduction of SAA and improvement of renal function. In light of the SAA1.3 allele significance in Japanese RA patients, both a tight control by disease-modifying antirheumatic drugs and an early intervention of biologics for RA inflammation should be applied to suppress acute-phase response, thus preventing the association of AA amyloidosis. It is suggested that SAA plays not only an important role in the development of AA amyloidosis but also interacts with events closely involved in metabolic syndrome as a high- and low-grade inflammatory modulator, respectively.

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Severe protein losing enteropathy with intractable diarrhea due to systemic AA amyloidosis, successfully treated with corticosteroid and octreotide

Cited by 52 publications

References 17 publications

Long-acting octreotide in the treatment of diarrhea after pelvic pouch surgery

Long-acting octreotide in the treatment of diarrhea after pelvic pouch surgery

Gastrointestinal and Hepatic Manifestations of Rheumatoid Arthritis

Clinical strategies for amyloid A amyloidosis secondary to rheumatoid arthritis

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