A rare cause of dysphagia and gastroparesis

Abstract

An 82-year-old woman was admitted with severe vomiting and progressive dysphagia mainly to solids. She gave a 3-month history of increasing heartburn, vomiting, tiredness, lethargy, anorexia and 13 kg weight loss. Her past medical history was unremarkable and she was a non-smoker. Physical examination revealed evidence of significant weight loss and dehydration only. Gastroscopy revealed mild oesophagitis, tongues of Barrett oesophagus and mild antral gastritis. CT scan of the thorax and abdomen was normal. Unfortunately her condition deteriorated rapidly and she died from aspiration pneumonia. Postmortem examination revealed thickening of the muscular wall of lower oesophagus and pylorus, but without any malignancy. The histological assessment of the oesophageal as well as gastric biopsies confirmed the diagnosis of gastrointestinal amyloidosis accounting for her symptoms of dysphagia and vomiting respectively.

Figure 1

Endoscopic appearance of lower end of the oesophagus and cardia.

Figure 2

Water-soluble contrast examination of the oesophagus (bilateral bronchial aspiration).

Figure 3

Water-soluble contrast examination of the oesophagus (hold up of contrast at gastro-oesophageal junction (GOJ), arrow).

Figure 4

Histological assessment of oesophageal mucosa (haematoxylin and eosin stain, ×200).

Figure 5

Histological assessment of oesophageal mucosa with Congo red stain (×200).