Extrapulmonary Sarcoidosis Manifested as Cirrhosis with Portal Hypertension

Kothakota, Sunil Raviraj; Nair, Ajith K.; Sasidharan, Madhu; Harish, K; Kumar, Chitresh; Kanala, Jagadeswarareddy

doi:10.34172/mejdd.2021.220

Cited by 1 publication

(3 citation statements)

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“…Despite its efficacy, the prolonged use of corticosteroids has to be balanced with wellknown adverse effects of weight gain, hyperglycaemia, and increased risk of infections, gastrointestinal bleeding, and metabolic bone disease. 9,50 A few studies have shown that UDCA may be effective in hepatic sarcoidosis, but mainly in patients with cholestasis or a predominant symptom of pruritus. The recommended dosage of 10 mg/kg/day used in most of the reported studies 27,30,51,52 demonstrated improvement in liver biochemistry and symptoms of cholestasis, particularly pruritus.…”

Section: Discussionmentioning

confidence: 99%

“…Despite its efficacy, the prolonged use of corticosteroids has to be balanced with well‐known adverse effects of weight gain, hyperglycaemia, and increased risk of infections, gastrointestinal bleeding, and metabolic bone disease. 9 , 50 …”

Section: Discussionmentioning

confidence: 99%

“…The lowest effective steroid dose was maintained for long‐term treatment in most studies, 48 provided there was a good initial response. Despite its efficacy, the prolonged use of corticosteroids has to be balanced with well‐known adverse effects of weight gain, hyperglycaemia, and increased risk of infections, gastrointestinal bleeding, and metabolic bone disease 9,50 …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The clinical management of hepatic sarcoidosis: A systematic review

Sinnanaidu,

Kumar,

Shunmugam

et al. 2024

JGH Open

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BackgroundHepatic sarcoidosis is an uncommon clinical condition in which clear recommendations are lacking in its treatment. We aimed to review systematically the literature on hepatic sarcoidosis treatment to guide clinicians.MethodsUsing MEDLINE, PubMed, CINAHL, Cochrane Library, and Google Scholar databases, we searched original articles on clinical studies reporting the outcome of adult hepatic sarcoidosis patients following treatment with various pharmacological agents. The primary end point was focused on assessing symptomatic relief and biochemical improvement posttreatment.ResultsOut of 614 retrieved references, 34 published studies were eligible, providing data for a total of 268 patients with hepatic sarcoidosis. First‐line therapy with corticosteroids alone was reported in 187 patients, whilst ursodeoxycholic acid (UDCA) was used in 40 patients. Symptomatic and biochemical responses were reported among 113(60.4%) and 80(42.8%) cases of corticosteroids respectively, whereas UDCA showed a complete response in 23(57.5%) patients. Second‐line therapy was used in steroid‐refractory cases, with most cases being reported for azathioprine (n = 32) and methotrexate (n = 28). Notably, 15(46.9%) and 11(39.2%) patients showed both clinical and biochemical responses respectively. Biological therapy including anti‐tumor necrosis factor (anti‐TNF) was used as third line therapy in twelve cases with a 72.7% symptomatic and biochemical response rate each.ConclusionThe quality of evidence for the treatment of hepatic sarcoidosis was poor. Nevertheless, it appears that corticosteroid or UDCA may be utilized as first‐line therapy. For cases that are refractory to corticosteroids, steroid‐sparing immunosuppressive agents and anti‐TNF have shown some promising results, but further high‐quality studies are required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%