Sarcoidosis is a systemic granulomatous disease of unknown etiology, characterized by the formation of noncaseating granulomas. Clinically recognizable gastrointestinal (GI) system involvement occurs in 0.1 to 0.9 percent of patients with sarcoidosis, while symptomatic hepatic involvement occurs in 5 to 15 percent. However, the incidence of subclinical involvement may be much higher. The stomach is the most commonly involved portion of the GI tract, but sarcoidosis has also been described in the esophagus, small intestine, appendix, colon, rectum, pancreas, and peritoneum [1-6].
The clinical features, diagnosis, and treatment of GI sarcoidosis will be reviewed here. The pathogenesis, clinical manifestations, diagnosis, and treatment of sarcoidosis affecting other organ systems are discussed separately. (See "Pathogenesis of sarcoidosis" and "Clinical manifestations and diagnosis of pulmonary sarcoidosis" and "Extrapulmonary manifestations of sarcoidosis".)
Gastrointestinal (GI) involvement by sarcoidosis may occur in a patient with known sarcoidosis or may be the initial manifestation. As granulomas in the GI tract have a number of causes depending on the exact site, establishing a diagnosis of GI sarcoidosis depends on three components:
●Biopsy evidence of noncaseating granulomas
●Exclusion of other causes of granulomatous disease, particularly mycobacterial, fungal, and parasitic infections