P029 Amyloidosis in Inflammatory Bowel Disease: Preliminary Results of screening in a selected population
O. Tayfur Yurekli*1, N.S. Buyukasik1, S. Orhun Yavuz2, M. Tahtaci1, A. Demirezer Bolat1, F.E. Akin1, H. Koseoglu1, M. Basaran1, E. Selvi1, O. Ersoy1
1Ankara Ataturk Research and Education Hospital, Gastroenterology, Ankara, Turkey, 2Ankara Ataturk Research and Education Hospital, Pathology, Ankara, Turkey
Amyloidosis is deposition of insoluble fibrils in extracellular space. Secondary amyloidosis(AA)is seen as a result of chronic inflammation.Amyloid fibrils are mainly deposited in kidneys, heart, spleen and liver. Kidney involvementmainly causes overt disease. Main treatment is the control of underlying disease. We have recently encountered an ulcerative colitis (UC) patient with renal amyloidosis leading to nephrotic range proteinuria.
We screened pathological specimens of 20 difficult to treat inflammatory bowel disease(IBD) patients ( 4 Crohn's, 16 UC )finding 2 more patients with amyloid staining in colonic biopsy specimens. We like to share our Results and provide a brief review about AA
First patient is a 43 year-old male with a 7 year history of UC who did not attend to regular follow up. His albumin was 2.14 g/dl, creatinin 0.62 mg/dl, sedimentation 85 mm/hr. Daily protein excretion was found to be 6450 mg. There was a fragile concentric narrowing between 8-23 cm of colon with pseudopolyps. Pathology confirmed the presence of amyloid in a vessel wall and AA type amyloidosis was detected after typing. The patient did not respond to medical therapy both in terms of proteinuria and diarrhea and surgery was advised. After that we retrospectively screened our 20 difficult to treat IBD patients . First is a recently diagnosed 54-year old female UC patient with a 30 year history of ankylosing spondylitis(AS).Reevaluation of the specimens revealed amyloid staining. Her albumin was 4.12 but she had 330 mg/day protein excretion, significant but not in the nephrotic range. Second is a 38 year old female with pancolitis diagnosed 2.5 years ago. Colonoscopy performed at initial diagnosis revealed multiple pseudopolyps across the whole colon suggesting the disease activity has been long going. Her serum albumin was 4.5 and again urine collection revealed 320 mg/day protein excretion.
Secondary amyloidosis in IBD is a rare entity mostly described for Crohn's disease .Incidence of secondary amyloidosis is reported to be < 1% in Crohn's disease and 7/10000 in UC. Predisposing factors are suppurative complications or extraintestinal manifestations.Resection of the involved bowel may be considered in selected cases. But most important is the medical treatment of the IBD.
Our 3 patients with amyloid staining suggest that uncontrolled disease activity may cause amyloid deposition in colon and possibly in kidneys. Clinical implication of amyloid positivity in IBD remains to be determined. Urinanalysis should be routinely performed in IBD patients.Serum albumin can be normal in amyloid positive patients.Also in difficult to treat patients histological specimens should be also be evaluated for amyloid staining.