Bleeding Varices Due to Portal Hypertension in Sarcoidosis

Extrapulmonary Sarcoidosis

“…[80][81][82] Portal hypertension can lead to esophageal and gastric variceal bleeding and death. 83,84 Although all patients with portal hypertension from sarcoidosis have significant hepatocellular disease, portal hypertension is the primary clinical abnormality. 65 Rarely, a patient with hepatic sarcoidosis may develop the Budd-Chiari syndrome.…”

Cholestatic Liver Disease

“…Another meta-analysis with broader inclusion criteria failed to show a survival benefit with U DCA (88). In tum, this meta-analysis was criticiz ed for inclusion of studies using ineffective doses of U DCA and short-term follow-up, since these provide alternative ex planations to the lack of survival benefit (89). Other lines of evidence for a survival benefit from U DCA have also been reported.…”

“…Because of an inverse relationship between smoking and risk of PSC, oral nicotine has been evaluated, but is poorly tolerated and without obvious benefit (88). D-Penicillamine which modulates the immune system and chelates copper (which may be increased in cholestasis) was not beneficial (89). A recent randomiz ed clinical trial of U DCA+ metronidaz ole vs. U DCA+ placebo found an improvement in AL P and the new Mayo Risk Score in patients receiving the antibiotic; however, no benefit was seen in disease progression assessed by biopsy or ERCP (90).…”

“…Although steroid therapy is the mainstay of treatment for pulmonary sarcoidosis, little data ex ist to validate or disprove their benefit in hepatic sarcoidosis. Whereas individual case series suggest that liver enz ymes may improve (88)(89)(90), others suggest that these improvements do not alter the natural history ofthe disease (91,92). Other therapies reported to have anecdotal efficacy include U DCA (93), chlorambucil (94 ), and chloroq uine (95).…”

Sarcoidosis – a clinically orientated review

“…Chronic cholestasis syndrome is a rare feature of hepatic sarcoidosis, presenting pruritus, jaundice, hepatomegaly, and marked elevations of serum alkaline phosphatase and cholesterol. Cirrhosis because of hepatic sarcoidosis has been observed in 6% of patients, and portal hypertension has been reported in 3% of cases , they can cause esophageal and gastric variceal bleeding and potentially death . Very rarely, hepatic veins getting narrowed by sarcoid granulomas, causing venous stasis and occlusion (Budd–Chiari syndrome) .…”