Amyloidosis presenting as postcricoid esophageal stricture

 CommentaryFirst described by Rokitansky in 1842, amyloidosis is now known to result from the deposition of insoluble proteinacious material that is produced in association with a variety of diseases and that may involve one or multiple organs. In the GI tract, amyloid may appear as ulcers, nodules, or polypoid masses and may have ischemic, malabsorptive, hemorrhagic, or dysmotility presentations. Indeed, it joins syphilis, cytomegalovirus, and lupus as another great imitator. The disease often is diagnosed by biopsy when Congo red staining demonstrates amyloid fibrillar protein. The term Congo red was introduced at the 1885 Berlin West Africa Conference as the name for the first direct textile dye. At that time, the Congo River basin was an exotic new geopolitical and potentially profitable area; hence, the name had marketing caché, just like another textile dye with an African name used in medicine: Sudan black. The inventor, Paul Bottiger, subsequently sold his patent rights for Congo red to a major German textile dyestuff company (AGFA) that ultimately merged with others to form the I.G. Farben Company. Congo red rarely is used today as a textile dye because it stains the fabrics of other garments when they are washed together. Unfortunately, there is no specific therapy for the disease, and median survival is only about a year. The take-home message here is to be aware of amyloid as a possibility even when you see what seems to be a familiar disease pattern, and especially when a patient has associated chronic inflammatory disease, multiple myeloma, or monoclonal gammopathy or is on hemodialysis. We often think of amyloid whenever a large tongue prevents the endoscope from being easily advanced into the posterior pharynx. Now when we enter the posterior pharynx and see nodules or upon seeing an esophageal stricture, we again should be reminded of Rokitansky's contribution.Lawrence J. Brandt, MDAssociate Editor for Focal Points

PII: S0016-5107(09)02339-6

doi:10.1016/j.gie.2009.08.013

© 2010 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.