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Gastrointestinal and hepatic sarcoidosis

Jeffrey S Berman, MD
Praveen Govender, MB Bch
Section Editors
Kevin R Flaherty, MD, MS
Talmadge E King, Jr, MD
Mark Feldman, MD, MACP, AGAF, FACG
Deputy Editor
Helen Hollingsworth, MD


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 regarded as the most commonly involved portion of the GI tract, but sarcoidosis has been described with equal frequency in the oral cavity and less frequently 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 "Pathology and 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. Definitive diagnosis of sarcoidosis in either context can be difficult, as granulomas in the tubular structures of the GI tract and liver have a number of etiologies. Demonstration of tissue granulomas is necessary for a diagnosis of sarcoidosis, but histology by itself is not enough to secure a diagnosis of sarcoidosis. Establishing a definitive diagnosis of GI sarcoidosis depends on three components:

Biopsy evidence of noncaseating granulomas in the "symptomatic or incident organ"

Exclusion of other causes of granulomatous disease, particularly mycobacterial, fungal, and parasitic infections

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Literature review current through: Oct 2017. | This topic last updated: Apr 29, 2016.
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