Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.
Eson Ekpo, Scripps Clinic, San Diego California

Main Body of the Abstract
Background:
Amyloidosis is a challenging multisystem entity characterized by the deposition of amyloid fibrils in various organs,including the heart, nervous system, and gastrointestinal tract (GI), leading to a spectrum of clinical manifestations. Amyloidosis of the GI tract, with biopsy-proven disease, is rare. This case sheds light on the pivotal role of GI tract biopsy in initiating the diagnostic cascade, ultimately leading to the identification and comprehensive management of cardiac amyloidosis.
Case:
An 87-year-old male with melena, 45-pound unintentional weight loss, and chronically elevated alkaline phosphatase underwent endoscopy and biopsy, revealing Congo red-positive staining in duodenal submucosal vessels (figure), confirming amyloidosis. Subtyping was hindered by limited tissue, prompting referral for cardiac evaluation. The patient exhibited atrial fibrillation, pseudoinfarct pattern on electrocardiogram, severe ventricular wall thickening on echocardiography, and chronically elevated cardiac biomarkers. Extracardiac manifestations included peripheral neuropathy, rotator cuff tear, and spinal stenosis. Normal kappa and lambda light chains and absence of monoclonal proteins in serum and urine were noted. A 99mTc-pyrophosphate scan confirmed diffuse myocardial uptake.
Decision Making:
Genetic testing ruled out hereditary subtypes, leading to a diagnosis of wild-type ATTR amyloidosis. Tafamidis was initiated for management.
Conclusion:
Gastrointestinal symptoms indicating ATTR amyloidosis are rare, emphasizing the importance of cardiac evaluation in extracardiac amyloidosis. GI symptoms can herald an unrecognized underlying amyloidogenic disease process. While screening methods exist for certain presentations, such as carpal tunnel syndrome, none currently exist for GI symptoms. Future studies may inform targeted screening strategies for amyloid in patients with identifiable GI symptoms "red flags."

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Eson Ekpo, Scripps Clinic, San Diego California

**Main Body of the Abstract**
**Background:**
Amyloidosis is a challenging multisystem entity characterized by the deposition of amyloid fibrils in various organs,including the heart, nervous system, and gastrointestinal tract (GI), leading to a spectrum of clinical manifestations. Amyloidosis of the GI tract, with biopsy-proven disease, is rare. This case sheds light on the pivotal role of GI tract biopsy in initiating the diagnostic cascade, ultimately leading to the identification and comprehensive management of cardiac amyloidosis.
**Case:**
An 87-year-old male with melena, 45-pound unintentional weight loss, and chronically elevated alkaline phosphatase underwent endoscopy and biopsy, revealing Congo red-positive staining in duodenal submucosal vessels (figure), confirming amyloidosis. Subtyping was hindered by limited tissue, prompting referral for cardiac evaluation. The patient exhibited atrial fibrillation, pseudoinfarct pattern on electrocardiogram, severe ventricular wall thickening on echocardiography, and chronically elevated cardiac biomarkers. Extracardiac manifestations included peripheral neuropathy, rotator cuff tear, and spinal stenosis. Normal kappa and lambda light chains and absence of monoclonal proteins in serum and urine were noted. A 99mTc-pyrophosphate scan confirmed diffuse myocardial uptake.
**Decision Making:**
Genetic testing ruled out hereditary subtypes, leading to a diagnosis of wild-type ATTR amyloidosis. Tafamidis was initiated for management.
**Conclusion:**
Gastrointestinal symptoms indicating ATTR amyloidosis are rare, emphasizing the importance of cardiac evaluation in extracardiac amyloidosis. GI symptoms can herald an unrecognized underlying amyloidogenic disease process. While screening methods exist for certain presentations, such as carpal tunnel syndrome, none currently exist for GI symptoms. Future studies may inform targeted screening strategies for amyloid in patients with identifiable GI symptoms "red flags."

Navigating the Diagnostic Odyssey: Unveiling Cardiac Amyloidosis through Gastrointestinal Biopsy PB34 (#277)

We invite you to attend the XIX International Symposium on Amyloidosis to be held in Rochester, MN.

This symposium is organized as a hybrid meeting (with the focus on in-person) held from Sunday, May 26 through Thursday, May 30, 2024.

Together with the ISA Board and members of Mayo Clinic, a very attractive scientific hybrid program is being planned. The program will cover a variety of types of systemic amyloidosis: ATTR (hereditary and wild-type), AL (light-chain), AA and less frequent forms. There will be key lectures, specific symposia including those company sponsored, oral presentations and poster sessions of accepted abstracts.

COURSE DESCRIPTION
This program will provide a comprehensive review of state-of-the-art education in systemic amyloidosis: basic science, pathophysiology, diagnosis, current and emerging treatments. Scientific presentations will include competitive oral and poster abstracts. The rapid evolution of scientific discovery and expanding treatment options has created tremendous interest in the field and this meeting will fill and important gap in educating scientists and clinicians.