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, although the incidence of subclinical involvement may be much higher. The stomach is the most commonly involved portion of the GI tract, but sarcoidosis of the esophagus, appendix, colon, rectum, pancreas, and peritoneum has also been described [1-5].
The clinical features and treatment of GI sarcoidosis will be reviewed here. Pathogenesis and other general issues related to sarcoidosis are discussed separately. (See "Clinical manifestations and diagnosis of sarcoidosis" and "Pathogenesis of sarcoidosis".)
Over 60 cases of symptomatic gastric sarcoidosis have been described in the literature. Of these, 25 patients had well documented histologic evidence of noncaseating granulomas consistent with sarcoidosis [6,7].
Clinical manifestations — Manifestations of gastric sarcoidosis are usually related either to the presence of peptic ulcerations or to narrowing of the gastric lumen due to granulomatous inflammation and associated fibrosis of the gastric wall; in the latter case diminished peristalsis often results . Epigastric pain is the predominant symptom in either circumstance. Abdominal pain is characteristically dull, burning, or cramping in nature and is often postprandial . Heartburn, generalized abdominal discomfort, and diarrhea may also be reported, and symptom complexes may be influenced by concomitant intestinal or rectal involvement. Nausea and vomiting may occur in the presence of pyloric obstruction. Weight loss is common and can be severe, often raising a suspicion of malignancy . Upper GI bleeding, although rare, can be the initial presentation and may occasionally be massive and fatal [11,12]. Many patients have diminished gastric acid secretion through an unclear mechanism.
Endoscopy — Upper gastrointestinal endoscopy is typically performed in patients with sarcoidosis who have persistent epigastric symptoms. Endoscopic findings in gastric sarcoidosis include nodular changes, gastritis, thickened mucosa, greater or lesser curvature deformities, and benign or malignant-appearing ulcers . Nodular mucosal irregularities are common, and mucosal polyps may occasionally be present .