Symptomatic gastric sarcoidosis in a patient with pulmonary sarcoidosis in remission

Shkolnik, Lauren E; Shin, Reuben D; Brabeck, David M; Rothman, Richard D

doi:10.1136/bcr-2012-006559

Cited by 9 publications

(5 citation statements)

References 11 publications

(7 reference statements)

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“…Granulomatous inflammation and fibrosis of the gastric wall can cause peptic ulcerations, narrowing of the gastric lumen, pyloric obstruction, and diminished peristalsis. Sarcoidosis can be concurrently active in one organ system and latent in another, making diagnosis and treatment difficult [ 4 ]. In fact, there are no published reports examining changes in lung lesions when gastric lesions recur; there does not appear to be a correlation in disease severity in one organ system (lung) based on expression of disease in another organ system (GI tract).…”

Section: Discussionmentioning

confidence: 99%

Treatment of a Gastrointestinal Sarcoidosis Flare: A Multidisciplinary Approach for a Multisystem Disease

2021

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Patient: Female, 68-year-old Final Diagnosis: Sarcoidosis Symptoms: Dysphagia • epigastric pain • nausea • vomiting Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Sarcoidosis is a multisystem granulomatous disease with predominant pulmonary involvement and rare gastrointestinal (GI) involvement. The stomach is the most common site when there is GI involvement. Symptomatic gastric sarcoidosis with biopsy-proven disease has rarely been reported and much of the knowledge is from case reports involving white patients. Case Report: Our unique case involves a flare of gastric sarcoid in an African American patient with biopsy-proven disease and we highlight our unique broad, multidisciplinary treatment approach that has not been described previously. A 68-year-old woman with pulmonary sarcoidosis presented with epigastric pain, nausea, vomiting, and dysphagia. The diagnosis of gastric sarcoid was made several years prior based on an upper endoscopy biopsy showing non-caseating granulomas in the antrum. She had previously experienced minimal relief of gastric symptoms with corticosteroids. In addition to a steroid taper, the patient experienced improvement in symptoms with a PPI (proton pump inhibitor), bowel regimen, and speech therapy techniques. Conclusions: Gastric symptoms can be a presenting sign for a sarcoid flare in a patient with pulmonary sarcoidosis, which is important for both pulmonologists and gastroenterologists to recognize. In addition to traditional therapy with corticosteroids, our unique broader, multidisciplinary approach with PPI, bowel regimen, and speech therapy techniques such as a liquid wash are important components of treatment for gastric sarcoid that have not been described in previous case reports.

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Section: Discussionmentioning

confidence: 99%

Treatment of a Gastrointestinal Sarcoidosis Flare: A Multidisciplinary Approach for a Multisystem Disease

2021

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“…There are no available clinical trials on the therapeutic management of gastric sarcoidosis, which is therefore mostly derived from the experience in pulmonary sarcoidosis [5]. The treatment of gastric sarcoidosis depends on symptoms -that is on both the severity and the extent of the disease [5,15,16]. Asymptomatic patients do not need any specific therapy [16].…”

Section: Discussionmentioning

confidence: 99%

Gastric sarcoidosis

Kasikovic-Lecic

Vucinic²,

Panjković

et al. 2017

Srp Arh Celok Lek

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Introduction Sarcoidosis is a systemic disease with a 90% predilection for the lungs, but any organ can be involved. Gastric sarcoidosis may be a component of a generalized process, while isolated gastric sarcoidosis is very rare. Case Outline We describe a rare case of biopsy-proven gastric sarcoidosis in a 45-year-old woman with pulmonary sarcoidosis in remission, and highlight the importance of gastroscopy and biopsy to confirm the diagnosis. Her optimal response to anti-acid therapy required no alternate (glucocorticoid) therapy. We briefly review the clinical, diagnostic, and therapeutic aspects of gastric sarcoidosis. Conclusion Glucocorticoids remain the cornerstone of the sarcoidosis treatment, although it has been insufficiently documented by clinical trials. The decision to treat sarcoid patients with systemic glucocorticoids is largely based upon the severity of symptoms. The anti-acid therapy may be an alternative in milder cases, as demonstrated in our patient.

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“…Clinically recognizable GI involvement is uncommon occuring in less than %1 of the patients, although the incidence of subclinical disease may be much higher [1,12,13]. On the other hand, granulomas in the gastric biopsy specimens are extremely rare and are mostly associated with Crohn's disease, tuberculosis, histoplasmosis, isolated granulomatous gastritis, vasculitis, and lymphoma [7,14,15,16].…”

Section: Discussionmentioning

confidence: 99%

Gastric Sarcoidosis: An Atypical Presentation of a Rare Disease

Yanardağ¹,

Tetikkurt²,

Bilir³

et al. 2017

AJMCR

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Sarcoidosis is a multisystemic granulomatous disease characterised by the histologic evidence of granulomas in various organs. Clinically discernible gastric sarcoidosis is extremely rare, reported in less than 1% of the patients. We present a case of gastric sarcoidosis with atypicial manifestations and without current pulmonary disease. The patient was admitted for gastric fullness, anorexia, and weight loss. She had a history of migraine and nodular goiter. Family history revealed bladder carcinoma in the mother and gastric carcinoma in the uncle. Initial laboratory findings and chest x-ray were normal. Biopsies from the gastric mucosa revealed noncaseating granulomas with focal multinucleate giant cells. Six months after the patient was admitted for dry cough and fatigue. Chest x-ray and CT revealed diffuse nodules in the upper and middle lung zones. Transbronchial biopsy demonstrated noncaseiting granulomas compatible with sarcoidosis. The patient was started on mehtylprednisolone and had a significant improvement in her symptoms. This case is an unique paradigm for the exceptional presentation of sarcoidosis. Isolated extrapulmonary organ involvement without simultaneous lung disease may be the initial manifestation of sarcoidosis. Meticulous follow-up for sarcoidosis is required for patients presenting with atypical symptoms and noncaseiting granulomas in any extrapulmonary organ.

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Symptomatic gastric sarcoidosis in a patient with pulmonary sarcoidosis in remission

Cited by 9 publications

References 11 publications

Treatment of a Gastrointestinal Sarcoidosis Flare: A Multidisciplinary Approach for a Multisystem Disease

Treatment of a Gastrointestinal Sarcoidosis Flare: A Multidisciplinary Approach for a Multisystem Disease

Gastric sarcoidosis

Gastric Sarcoidosis: An Atypical Presentation of a Rare Disease

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