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1
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Pezhouh MK, Lam-Himlin D, Zaheer A, Voltaggio L. Systemic diseases affecting the GI tract: A review of clinical and histopathologic manifestations. Ann Diagn Pathol 2024; 73:152351. [PMID: 39004038 DOI: 10.1016/j.anndiagpath.2024.152351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 05/31/2024] [Indexed: 07/16/2024]
Abstract
A variety of systemic diseases may affect the gastrointestinal (GI) tract. Since the GI tract responds to injury in limited ways, identifying these processes may be challenging, especially on small endoscopic biopsies. This article reviews the clinicopathologic features of commonly encountered systemic diseases affecting the tubular GI tract: sarcoidosis, graft vs. host disease, mast cell disorders, systemic sclerosis, and IgG-4 related disease. In addition, we offer guidance in differentiating them from their mimics.
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Affiliation(s)
- Maryam K Pezhouh
- University of California San Diego, Department of Pathology, CA, United States of America
| | - Dora Lam-Himlin
- Mayo Clinic, Department of Laboratory Medicine and Pathology, AZ, United States of America
| | - Atif Zaheer
- Johns Hopkins University, Department of Radiology, MD, United States of America
| | - Lysandra Voltaggio
- Johns Hopkins University, Department of Pathology, MD, United States of America.
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2
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Nadpara N, Greenwald HS, Parkman HP. Treatment of a Gastrointestinal Sarcoidosis Flare: A Multidisciplinary Approach for a Multisystem Disease. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932494. [PMID: 34552042 PMCID: PMC8477980 DOI: 10.12659/ajcr.932494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patient: Female, 68-year-old
Final Diagnosis: Sarcoidosis
Symptoms: Dysphagia • epigastric pain • nausea • vomiting
Medication: —
Clinical Procedure: —
Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Neil Nadpara
- Section of Gastroenterology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Holly S Greenwald
- Section of Gastroenterology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Henry P Parkman
- Section of Gastroenterology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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3
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Tana C, Donatiello I, Coppola MG, Ricci F, Maccarone MT, Ciarambino T, Cipollone F, Giamberardino MA. CT Findings in Pulmonary and Abdominal Sarcoidosis. Implications for Diagnosis and Classification. J Clin Med 2020; 9:jcm9093028. [PMID: 32962242 PMCID: PMC7565100 DOI: 10.3390/jcm9093028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/02/2020] [Accepted: 09/18/2020] [Indexed: 12/13/2022] Open
Abstract
Sarcoidosis is a granulomatous disorder of unknown etiology characterized by noncaseating granulomas virtually in every organ and tissue. This finding represents the most important diagnostic clue to reach a correct definition of sarcoidosis, although the biopsy is invasive and has several risk procedures. Several efforts are made to suspect the diagnosis of sarcoidosis by combining noninvasive elements, in particular from imaging, though these findings are often nonspecific and reflect the wide multifactorial pathogenesis. Every effort should be made to obtain a detailed radiological picture that, if associated with a suggestive clinical picture, could avoid the need of biopsy in some specific cases. In this narrative review, we aim to describe main computed tomography (CT) features of pulmonary and abdominal sarcoidosis, by reporting strengths and limits of this technique, in particular for the identification of extrapulmonary, isolated disease.
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Affiliation(s)
- Claudio Tana
- Geriatrics Clinic, “G. Bernabeo” Hospital, Contrada S. Liberata, 66026 Ortona (CH), Italy
- Correspondence: ; Tel./Fax: +39-085-9172287
| | - Iginio Donatiello
- Internal Medicine Unit, University Hospital of Salerno, 84131 Salerno, Italy;
| | | | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, “G.d’Annunzio” University, 66100 Chieti, Italy;
| | | | | | - Francesco Cipollone
- Medical Clinic, Department of Medicine and Science of Aging, “G. D’Annunzio”, University of Chieti, 66100 Chieti, Italy;
| | - Maria Adele Giamberardino
- Geriatrics Clinic, Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, 66100 Chieti, Italy;
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4
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Abstract
Involvement of the gastrointestinal (GI) tract is an infrequent extrathoracic presentation of sarcoidosis. We reviewed 305 cases of GI involvement reported in 238 patients, in whom GI sarcoidosis was the first sign of the disease in half the cases. The disease does not affect the GI tract uniformly, with a clear oral-anal gradient (80% of reported cases involved the esophagus, stomach, and duodenum). Clinicopathological mechanisms of damage may include diffuse mucosal infiltration, endoluminal exophytic lesions, involvement of the myenteric plexus, and extrinsic compressions. Ten percent of patients presented with asymptomatic or subclinical disease found on endoscopy. The diagnosis is relevant clinically because 22% of cases reviewed presented as life threatening. In addition, initial clinical/endoscopic findings may be highly suggestive of GI cancer. The therapeutic approach is heterogeneous and included wait-and-see or symptomatic approaches, glucocorticoid/immunosuppressive therapy, and surgery. Sarcoidosis of the gut is a heterogeneous, potentially life-threatening condition that requires a multidisciplinary approach and early clinical suspicion to institute personalized therapeutic management and follow-up.
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5
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Sangineto M, Luglio CV, Suppressa P, Sabbà C, Napoli N. A case of sarcoidosis with isolated hepatosplenic onset and development of inflammatory bowel disease during recovery stage. AUTOIMMUNITY HIGHLIGHTS 2017; 8:6. [PMID: 28455816 PMCID: PMC5408327 DOI: 10.1007/s13317-017-0094-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/12/2017] [Indexed: 11/11/2022]
Abstract
Sarcoidosis is a systemic disease characterized by an immune-mediated disorder, which leads to the development of non-caseating granulomas in the involved organs. More than 90% of patients with sarcoidosis present lungs and lymphatic system involvement at onset, while less than 10% has an isolated extrapulmonary localization. Here, we describe the case of an elderly patient with isolated hepato-splenic onset (multiple splenic lesions at imaging and cholestasis), and subsequent pulmonary involvement. The liver biopsy showed the presence of non-caseating granulomas, suggesting sarcoidosis. Despite the complete recovery was obtained with steroid therapy, after dosage reduction the patient presented watery diarrhea. Endoscopic investigations with biopsies were performed, describing the presence of an important lympho-plasmacytic infiltrate of terminal ileum mucosa with typical aspects of inflammatory bowel disease. The symptomatology completely disappeared after steroid dosage increase. This case confirms that sarcoidosis could present in a very atypical way, involving several organs in a different manner at the same time and that every symptom should not be underestimated, despite the rare presentation.
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Affiliation(s)
- Moris Sangineto
- Clinica Medica "Cesare Frugoni", Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - Chiara Valentina Luglio
- Clinica Medica "Cesare Frugoni", Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Patrizia Suppressa
- Clinica Medica "Cesare Frugoni", Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Carlo Sabbà
- Clinica Medica "Cesare Frugoni", Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Nicola Napoli
- Clinica Medica "Cesare Frugoni", Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
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6
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Gezer NS, Başara I, Altay C, Harman M, Rocher L, Karabulut N, Seçil M. Abdominal sarcoidosis: cross-sectional imaging findings. Diagn Interv Radiol 2016; 21:111-7. [PMID: 25512071 DOI: 10.5152/dir.2014.14210] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sarcoidosis is a multisystem inflammatory disease of unknown etiology. The lungs and the lymphoid system are the most commonly involved organs. Extrapulmonary involvement is reported in 30% of patients, and the abdomen is the most common extrapulmonary site with a frequency of 50%-70%. Although intra-abdominal sarcoidosis is usually asymptomatic, its presence may affect the prognosis and treatment options. The lesions are less characteristic and may mimick neoplastic or infectious diseases such as lymphoma, diffuse metastasis, and granulomatous inflammation. The liver and spleen are the most common abdominal sites of involvement. Sarcoidosis of the gastrointestinal system, pancreas, and kidneys are extremely rare. Adenopathy which is most commonly found in the porta hepatis, exudative ascites, and multiple granulomatous nodules studding the peritoneum are the reported manifestations of abdominal sarcoidosis. Since abdominal sarcoidosis is less common and long-standing, unrecognized disease can result in significant morbidity and mortality. Imaging contributes to diagnosis and management of intra-abdominal sarcoidosis. In this report we reviewed the cross-sectional imaging findings of hepatobiliary, gastrointestinal, and genitourinary sarcoidosis.
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Affiliation(s)
- Naciye Sinem Gezer
- Department of Radiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
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7
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Mizuno K, Kato N, Sugihara A, Okamoto H. Lupus pernio with 2 years of preceding symptomatic gastric sarcoidosis. J Dermatol 2015; 42:330-1. [PMID: 25572275 DOI: 10.1111/1346-8138.12771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kana Mizuno
- Department of Dermatology, Kansai Medical University, Hirakata, Osaka, Japan
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8
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Eklund A, du Bois RM. Approaches to the treatment of some of the troublesome manifestations of sarcoidosis. J Intern Med 2014; 275:335-49. [PMID: 24433397 DOI: 10.1111/joim.12198] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Sarcoidosis can be a major therapeutic challenge given its multiplicity of clinical presentations, variable combination of organ involvement and severity, and unpredictable longitudinal behaviour. Six manifestations of sarcoidosis are especially difficult to manage because of (i) an incomplete knowledge of causation - fatigue and small fibre neuropathy, (ii) the rare occurrence in sarcoidosis - intra-abdominal complications or (iii) the potentially life-threatening consequences in some patients - neurological disease, pulmonary hypertension and hypercalcaemia. In none of these situations have a prospective, double-blind, placebo-controlled trial of any therapy been conducted. Despite this absence of any firm evidence base to support therapeutic recommendations, these six entities can be extremely problematic for the practising clinician. It is for this reason that we have focused in this review on these six disease manifestations and provided a synopsis of each problem together with suggested treatment approaches, based on an analysis of the current literature.
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Affiliation(s)
- A Eklund
- Department of Medicine, Karolinska University Hospital, Karolinska Institutet and Centre for Molecular Medicine, Stockholm, Sweden
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9
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Goel R, Deere H, Kariyawasam V. Granulomatous gastritis causing partial gastric outflow obstruction. Clin Gastroenterol Hepatol 2013; 11:A22. [PMID: 23403008 DOI: 10.1016/j.cgh.2013.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 02/01/2013] [Indexed: 02/07/2023]
Affiliation(s)
- Rishi Goel
- Department of Gastroenterology, St Thomas' Hospital, London, United Kingdom
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10
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Ungprasert P, Kue-A-Pai P, Srivali N, Cheungpasitporn W, Griger DT. A rare case of symptomatic gastric sarcoidosis. QJM 2013; 106:569-70. [PMID: 23483139 DOI: 10.1093/qjmed/hct067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Ungprasert
- Department of Internal Medicine, 202-251-5057 Bassett Medical Center, 1 Atwell Road, Cooperstown, NY 13326, USA.
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11
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Esophageal sarcoidosis: a review of cases and an update. ISRN GASTROENTEROLOGY 2013; 2013:836203. [PMID: 23533794 PMCID: PMC3603204 DOI: 10.1155/2013/836203] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 01/30/2013] [Indexed: 12/19/2022]
Abstract
Sarcoidosis is a chronic disorder that can virtually affect any organ system in the body. Histologically, it is characterized by the presence of T lymphocytes, mononuclear phagocytes, and noncaseating granulomas. Most commonly affected are the intrathoracic structures, with 90% of the reported cases involving the lungs. Esophageal involvement in sarcoidosis is extremely rare. Dysphagia is the most common presentation in these patients and can be attributed to various mechanisms such as direct esophageal wall infiltration, extrinsic compression, cranial neuropathy, and brainstem involvement. A thorough online literature review revealed only 23 reported cases of esophageal involvement in sarcoidosis. This paper reviews these reported cases in detail along with newer diagnostic and treatment options, including direction of future therapy.
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12
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Shkolnik LE, Shin RD, Brabeck DM, Rothman RD. Symptomatic gastric sarcoidosis in a patient with pulmonary sarcoidosis in remission. BMJ Case Rep 2012; 2012:bcr-2012-006559. [PMID: 22802571 DOI: 10.1136/bcr-2012-006559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sarcoidosis is a multisystem, non-infectious, granulomatous disease of unknown cause, characterised by histological evidence of non-caseating granulomas. Gastrointestinal (GI) involvement is uncommon, reported in <1% of patients with the disease. Herein, we present a rare case of isolated gastric sarcoidosis in a patient with latent pulmonary sarcoidosis and unexplained manifestations of GI disease, illustrating that clinical disease expression is variable; may be organ-specific; and, known disease latency confined to one organ does not exclude the possibility of active disease in another organ system. In patients with organ-specific sarcoidosis, whether active or in remission, presenting with GI symptoms, the possibility of gastric sarcoidosis should be considered. Oesophagogastroduodenoscopy and biopsy, when indicated, should be considered for definitive diagnosis.
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Affiliation(s)
- Lauren E Shkolnik
- Department of Medicine, Lahey Clinic Medical Center, Burlington, Massachusetts, USA
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13
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Disseminated sarcoidosis presenting as granulomatous gastritis: a clinical review of the gastrointestinal and hepatic manifestations of sarcoidosis. J Clin Gastroenterol 2012; 46:367-74. [PMID: 22334224 DOI: 10.1097/mcg.0b013e318247106b] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Commonly considered a pulmonary disease, sarcoidosis is actually a multisystemic granulomatous disorder of unclear etiology. There is a wide range of organ system involvement, with gastrointestinal being among the rarest. We describe the diagnostic challenge of a patient presenting with gastritis without pulmonary complaints who was later found to have extrathoracic disseminated sarcoidosis. This case highlighted both the variability in the presentation of the disease and difficulties in its diagnosis. We performed a literature review to identify studies published on gastrointestinal and hepatic sarcoidosis to better understand the characteristics of this disease and help in the differentiation between other commonly encountered disorders that may be mimicked in presentation. We have also created a diagnostic approach that can be applied when endoscopic or hepatic biopsies reveal granulomas. We anticipate that this review may be useful for clinicians who face these diagnostic dilemmas and management decisions for this complex and variable condition.
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14
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Afshar K, BoydKing A, Sharma OP, Shigemitsu H. Gastric sarcoidosis and review of the literature. J Natl Med Assoc 2010; 102:419-22. [PMID: 20533777 DOI: 10.1016/s0027-9684(15)30577-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Sarcoidosis is a systemic disease with a 90% predilection for the lungs, but any organ can be involved. Gastrointestinal involvement is rare. Within the gastrointestinal system, gastric involvement is the most common. When this organ system is involved, it can be a feature of systemic disease or an isolated case. Gastrointestinal sarcoid can resemble a broad spectrum of other disease processes; thus, it is important for health care providers to be familiar with the various gastrointestinal manifestations. Patients can have subclinical symptoms or have symptoms of epigastric pain, nausea, vomiting, and hematemesis. We present 2 cases of gastric sarcoid and a MEDLINE search of 44 reported cases of gastric sarcoid based on a compatible history and the demonstration of noncaseating granulomas. We describe the clinical manifestations of symptomatic gastric sarcoid in relation to the endoscopic findings.
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Affiliation(s)
- Kamyar Afshar
- University of Southern California, Keck School of Medicine, Division of Pulmonary and Critical Care, 1200 N State St, GH 11900, Los Angeles, CA 90033, USA.
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16
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17
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Jain R, L. Thiele D. Gastrointestinal and Hepatic Manifestations of Systemic Diseases. SLEISENGER AND FORDTRAN'S GASTROINTESTINAL AND LIVER DISEASE 2010:557-592.e11. [DOI: 10.1016/b978-1-4160-6189-2.00035-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Ebert EC, Kierson M, Hagspiel KD. Gastrointestinal and hepatic manifestations of sarcoidosis. Am J Gastroenterol 2008; 103:3184-92; quiz 3193. [PMID: 18853979 DOI: 10.1111/j.1572-0241.2008.02202.x] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sarcoidosis is a multisystem disease characterized by noncaseating granulomas in the affected organs, including skin, heart, nervous system, and joints. Diagnosis of sarcoidosis is generally based upon a compatible history, demonstration of granulomas in at least two different organs, negative staining and culture for acid fast bacilli, absence of occupational or domestic exposure to toxins, and lack of drug-induced disease. Involvement of the hollow organs is rare. Rather than being due to sarcoidosis, some reported mucosal lesions may simply have incidental granulomas. Extrinsic compression from lymphadenopathy can occur throughout the gastrointestinal tract. The stomach, particularly the antrum, is the most common extrahepatic organ to be involved, while the small bowel is the least common. Liver involvement frequently occurs and ranges from asymptomatic incidental granulomas to portal hypertension from granulomas in the portal triad, usually with relatively preserved liver function. CT scans show hepatosplenomegaly and adenopathy, followed in frequency by focal low-attenuation lesions of the liver and spleen. Ascites is usually a transudate from right heart failure (because of pulmonary hypertension) or portal hypertension (because of biliary cirrhosis). Rarely, an exudative ascites may occur from studding of the peritoneum with nodules. Pancreatic involvement presents as a mass, usually in the head or a diffusely firm, nodular organ. Corticosteroids should be instituted when organ function is threatened, usually lungs, eyes, and central nervous system. Their role in the treatment of hepatic sarcoidosis is unclear. The overall prognosis is good although most patients will have some permanent organ impairment. Cardiac and pulmonary diseases are the main causes of death.
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Affiliation(s)
- Ellen C Ebert
- Department of Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903, USA
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19
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Vahid B, Spodik M, Braun KN, Ghazi LJ, Esmaili A. Sarcoidosis of gastrointestinal tract: a rare disease. Dig Dis Sci 2007; 52:3316-20. [PMID: 17410465 DOI: 10.1007/s10620-006-9448-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Accepted: 05/12/2006] [Indexed: 01/10/2023]
Abstract
Gastrointestinal (GI) tract sarcoidosis is an uncommon form of sarcoidosis. The GI tract can be involved as an isolated disease as a part of systemic sarcoidosis. Clinical manifestations of esophageal, gastric, small bowel, colon, and appendicular sarcoidosis are discussed in this review. The differential diagnosis of GI sarcoidosis is extensive. Other granulomatous diseases of the GI tract, like tuberculosis, fungal infections, parasitic diseases, inflammatory bowel disease, and Whipple's disease, should be excluded before making the diagnosis of GI sarcoidosis. Corticosteroid therapy is effective in treatment of GI sarcoidosis. Surgical intervention may be necessary in patients with bowel obstruction, perforation, or massive hemorrhage.
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Affiliation(s)
- Bobbak Vahid
- Thomas Jefferson University Hospital, Department of Pulmonary and Critical Care Medicine, 834 Walnut Street Suite 650, Philadelphia, PA 19107, USA.
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20
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Abstract
Sarcoidosis is a systemic granulomatous disease of unknown etiology that is characterized by the formation of noncaseating granulomas. Gastrointestinal (GI) tract involvement in sarcoidosis is rare. Gastric sarcoidosis, particularly involving the antrum, affects approximately 10% of patients with systemic disease. GI sarcoidosis commonly occurs subclinically, with clinical manifestations present in only 0.1 to 0.9% of patients with the disease. This is a rare case report of an individual with symptomatic gastric sarcoidosis. The patient presented with weight loss, nausea, and early satiety. An EGD and colonoscopy were performed and were grossly normal. However, biopsies of the gastric antrum revealed noncaseating granulomatous inflammation involving the gastric mucosa. Corticosteroid therapy was started and the symptoms abated almost immediately. We also offer a review of the literature.
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Affiliation(s)
- Mark Friedman
- Division of Gastroenterology and Liver Diseases, George Washington University, 2150 Pennsylvania Avenue, NW, Suite 3-408, Washington, DC 20037, USA.
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21
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Leeds JS, McAlindon ME, Lorenz E, Dube AK, Sanders DS. Gastric sarcoidosis mimicking irritable bowel syndrome-Cause not association? World J Gastroenterol 2006; 12:4754-6. [PMID: 16937452 PMCID: PMC4087846 DOI: 10.3748/wjg.v12.i29.4754] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Sarcoidosis is a systemic disease of unknown aetiology that may affect any organ in the body. The gastrointestinal tract however is only rarely affected outside the liver. Symptoms may be non-specific. Irritable bowel syndrome (IBS) is a common diagnosis. The recognition of IBS is aided by the use of the Rome II criteria - in the absence of organic disease. We describe the first case of a patient with gastric sarcoidosis who presented with IBS symptoms but subsequently responded to immunosuppressive therapy.
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Affiliation(s)
- John Samuel Leeds
- Room P39, Department of Gastroenterology and Liver unit, Royal Hallamshire Hospital, Sheffield, South Yorkshire, S10 2JF, United Kingdom.
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22
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23
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Kawaura K, Takahashi T, Kusaka K, Yamakawa J, Itoh T, Kanda T. Spontaneously identified gastric sarcoidosis: a report of three cases. J Int Med Res 2003; 31:239-43. [PMID: 12870379 DOI: 10.1177/147323000303100312] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sarcoidosis is a systemic granulomatous disease, frequently involving the lungs, lymph nodes, eyes and skin. Gastric sarcoidosis is very rare. We report three patients diagnosed initially with gastric sarcoidosis. Two had no other identified involvement, and one had involvement of the lungs and hilar lymph nodes. Gastroscopy was performed because of abdominal discomfort or as a follow-up examination for partial gastrectomy. This revealed atrophic lesions with nodular mucosal changes in the antrum and granular mucosa, and residual gastritis was found at the site of gastroduodenal anastomosis. Non-caseating epitheloid-cell granulomas were found in all patients following histological analysis. Gastroscopy and histopathological findings in gastric mucosal biopsy samples from suspicious sites are essential in establishing an accurate diagnosis of gastric sarcoidosis.
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Affiliation(s)
- K Kawaura
- Department of General Medicine, Kanazawa Medical University, Ishikawa, Japan
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24
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Affiliation(s)
- R Dohil
- Division of Gastroenterology, British Columbia Children's Hospital, Vancouver, Canada
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25
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Affiliation(s)
- C De Angelis
- Dipartimento di Gastroenterologia, Azienda Ospedaliera San Giovanni Battista, Torino, and the Dipartimento di Medicina Interna, Università di Torino, Torino, Italy
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26
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Noël JM, Katona IM, Piñeiro-Carrero VM. Sarcoidosis resulting in duodenal obstruction in an adolescent. J Pediatr Gastroenterol Nutr 1997; 24:594-8. [PMID: 9161957 DOI: 10.1097/00005176-199705000-00018] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- J M Noël
- Department of Pediatrics and Medicine, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814-4799, USA
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27
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Zuckerman MJ, al-Samman M, Boman DA. Granulomatous gastroenteritis. Case report with comparison to idiopathic isolated granulomatous gastritis. Dig Dis Sci 1994; 39:1649-54. [PMID: 8050313 DOI: 10.1007/bf02087771] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A woman with epigastric pain, vomiting, weight loss, and an upper gastrointestinal series showing antral rigidity suggestive of linitis plastica was found to have granulomatous inflammation of the stomach. Additional investigations disclosed more extensive gastrointestinal involvement, with noncaseating granulomas found in esophageal and colonic mucosa, despite normal appearances at endoscopy. Intestinal permeability to [51Cr]EDTA was increased, suggesting intestinal mucosal injury. No specific entity, including disseminated sarcoidosis or Crohn's disease, was diagnosed. This patient with granulomatous gastroenteritis had a clinical and histologic response to medical therapy with prednisone and recurrence of symptoms when prednisone was tapered. Her clinical course was similar to that of previous cases of idiopathic isolated granulomatous gastritis treated nonsurgically. Cases of idiopathic isolated granulomatous gastritis should be categorized as such only if a thorough evaluation has been performed to determine extent of disease, as well as to exclude other entities.
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Affiliation(s)
- M J Zuckerman
- Department of Medicine, Texas Tech University Health Sciences Center, El Paso 79905
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Affiliation(s)
- C D George
- Department of Radiology, St George's Hospital and Medical School, London
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Affiliation(s)
- A B Price
- Department of Histopathology, Northwick Park Hospital, Harrow, Middlesex, UK
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Stampfl DA, Grimm IS, Barbot DJ, Rosato FE, Gordon SJ. Sarcoidosis causing duodenal obstruction. Case report and review of gastrointestinal manifestations. Dig Dis Sci 1990; 35:526-32. [PMID: 2180656 DOI: 10.1007/bf01536930] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- D A Stampfl
- Department of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania 19107
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Dörfler H, Conca W, Remberger K. [Granulomatous gastritis of the antrum in generalized sarcoidosis]. KLINISCHE WOCHENSCHRIFT 1986; 64:1139-43. [PMID: 3807261 DOI: 10.1007/bf01726876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A 42-year-old man had a 4 year history of sarcoidosis stage II (lung). In biopsied specimens of the antrum we found epithelioid granulomas caused by gastric involvement in sarcoidosis. Coincidentally we found a gastric ulcer which was later the source of gastric bleeding. The granulomas were located around this ulcer and also under intact mucosa. Therefore, in our opinion it was not the case that granulomatous gastritis caused the ulceration in a direct way. We saw a connection between hypercalcemia--often found in patients with sarcoidosis, as in our patient--and the gastric ulcer. Therapy was thus aimed at lowering the blood calcium concentration. Steroids were avoided at this time. The ulceration healed, although granulomatous gastritis continued.
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Abstract
We report a patient with both sarcoidosis and Crohn's colitis, an association not previously documented. We review the literature and discuss the areas of overlap in these two conditions.
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