Methadone use and asymptomatic common bile duct dilation: Re-examining the link.

Opiates have long been implicated in causing common bile duct (CBD) dilation but few studies have been done to look at the association between synthetic opiates - methadone - and asymptomatic CBD dilation. The mechanism by which methadone could cause CBD dilation is poorly understood, but it has been postulated that increase in biliary pressures from contraction of the sphincter of Oddi is likely. In the below article, we review all the evidence pertaining towards methadone causing common bile duct dilation.

Primary systemic amyloidosis with extensive gastrointestinal involvement.

We report this case of a 42-year-old woman who presented with a debilitating illness manifested by intractable nausea, vomiting, diarrhea and unchecked weight loss. The patient had multisystem involvement that presented as anemia, abnormal liver function tests and progressively deteriorating renal function necessitating dialysis. She was found to be profoundly hypoalbuminemic secondary to malabsorptive and protein-losing enteropathy in tandem with nephrotic range proteinuria. Intolerance to enteral feeding led the patient to be dependent on parenteral nutrition. Serum immunofixation revealed IgG lambda monoclonal protein. The patient underwent endoscopic evaluation with biopsies taken from the gastrointestinal tract that confirmed the diagnosis of primary systemic light-chain amyloidosis. A subsequent bone marrow biopsy revealed normocellular bone marrow with deposition of amyloid. The patient was not considered for autologous stem cell transplantation as the outcomes in patients with multisystem involvement are often poor, with a high mortality risk. Diffuse primary systemic light-chain amyloidosis involving the gastrointestinal tract is a rare entity and is to be considered among differentials in patients presenting with unexplained malabsorptive symptoms.