Gastrointestinal sarcoidosis

INTRODUCTION

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, and pancreas have 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".)

The American Thoracic Society (ATS) statement on sarcoidosis, as well as other ATS guidelines, can be accessed through the ATS web site at www.thoracic.org/sections/publications/statements/index.html.

GASTRIC

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].

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 [7]. Epigastric pain is the predominant symptom in either circumstance, and nausea and vomiting may occur in the presence of pyloric obstruction. Abdominal pain is characteristically dull, burning, or cramping in nature and is often postprandial [8]. Heartburn, generalized abdominal discomfort, and diarrhea may also be reported, and symptom complexes may be influenced by concomitant intestinal or rectal involvement. Weight loss is common and can be severe, often raising a suspicion of malignancy [9]. Upper GI bleeding, although rare, can be the initial presentation and may occasionally be massive and fatal [10,11]. Many patients have diminished gastric acid secretion through an unclear mechanism.