Upper Gastrointestinal Sarcoidosis: Report of Three Cases

Inomata, Minoru; Ikushima, Soichiro; Awano, Nobuyasu; Kondoh, Keisuke; Satake, Kohta; Masuo, Masahiro; Moriya, Atsuko; Kamiya, Hiroyuki; Ando, Tsunehiro; Azuma, Arata; Takemura, Tamiko

doi:10.2169/internalmedicine.51.7367

Cited by 19 publications

(13 citation statements)

References 9 publications

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“…Although anti-acid therapy, including PPIs, may have efficacy in gastric sarcoidosis as well as peptic ulcer and gastroesophageal reflux disease, improvement with PPIs alone is limited[9]. Therefore, prednisone at 30 to 40 mg a day is the first-line treatment for symptomatic patients[4,5].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of additional treatment with azathioprine in a patient with prednisolone-dependent gastric sarcoidosis

Murata

Sugimoto

Yokota

et al. 2016

WJG

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Gastric sarcoidosis with noncaseating granuloma is rare. Although corticosteroid produces a dramatic clinical response, it is unknown whether azathioprine show efficacy in prednisolone-dependent cases. Here, we report a case of gastric sarcoidosis in a 25-year-old man with severe epigastlargia. Gastroendoscopy revealed multiple map-like ulcerations. Histological examination showed multiple noncaseating granulomatous lesions in gastric mucosa, which were incompatible with diagnoses of Crohn’s disease or tuberculosis. He was started on prednisolone at 30 mg/d, and his symptoms improved within 7-d. The prednisolone was gradually tapered by 5 mg every 2-wk, but oral azathioprine at 50 mg was added after symptoms recurred at tapered dose of 10 mg. Endoscopy 4-wk later showed healing ulcers, and, lymphocytic infiltration was absent. The efficacy of additional azathioprine in gastric sarcoidosis is not well defined. Here, we report a case of prednisolone-dependent gastric sarcoidosis that improved after additional azathioprine, and also review the literature concerning the treatment, especially for prednisolone-dependent cases.

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Section: Discussionmentioning

confidence: 99%

Efficacy of additional treatment with azathioprine in a patient with prednisolone-dependent gastric sarcoidosis

Murata

Sugimoto

Yokota

et al. 2016

WJG

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“…Outras vezes, podemos ver ulcerações da mucosa com ou sem eritema e lesões polipoides/ nodulares (granulomas). 10,11 Em pacientes assintomáticos, a mucosa gástrica pode ser normal. 1 Quatro categorias principais de lesões podem ser distinguidas: subclínica (a mais comum), ulcerativa, infiltrativa e polipoide.…”

Section: Discussionunclassified

Disseminated sarcoidosis: pulmonary, endobronchial and gastric

Monção

Ribeiro

Souza

et al. 2016

Medicina (Ribeirão Preto)

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RESUMOA sarcoidose é uma doença granulomatosa crônica idiopática, de caráter sistêmico. Embora o acometimento pulmonar seja a forma mais comum da doença, a sarcoidose pode afetar as vias aéreas, determinando nodulações de mucosa e até estenose brônquica. O envolvimento do trato gastrointestinal é bastante raro e se manifesta principalmente como sarcoidose gástrica. O diagnóstico se baseia na sintomatologia, nos achados radiológicos e na análise histopatológica das biópsias teciduais. No presente trabalho, descrevemos um caso de sarcoidose pulmonar, endobrônquica e gástrica em uma mesma paciente e discutimos a abordagem dessa rara apresentação da doença. Palavras-chave: Sarcoidose. Sarcoidose gástrica. Massa endobrônquica. Caso clínico ABSTRACTSarcoidosis is a chronic granulomatous idiopathic systemic disease. Although the pulmonary involvement is the most common form of the disease, sarcoidosis can affect the airways, determining mucosal nodularity and even bronchostenosis. Gastrointestinal involvement is very rare and it is primarily manifested as gastric sarcoidosis. The diagnosis is based on symptoms, radiological findings and histopathological examination of tissue biopsies. In this work, we describe a case of pulmonary, endobronchial and gastric sarcoidosis in the same patient and discuss the approach to this rare presentation of the disease.Keywords: Sarcoidosis. Gastric sarcoidosis. Endobronchial mass. Clinical case. IntroduçãoA sarcoidose é uma doença sistêmica de etiologia desconhecida que se caracteriza por inflamação granulomatosa não caseosa que pode afetar qualquer órgão, principalmente os pulmões. 1 A sarcoidose pulmonar é uma das causas mais comuns de doença intersticial pulmonar, sendo o trato respiratório o mais acometido. 2,3O diagnósti-co é baseado nas suspeitas clínica e radiológica e o achado radiológico mais comum é a linfonodomegalia hilar bilateral com infiltrado pulmonar tipicamente de distribuição perivascular. 4 Quando afeta as vias aéreas, a sarcoidose pode determinar a formação de nódulos ou placas associados a eritema e/ou edema de mucosa, estenose brônquica, bron-

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“…Conversely, GI tract involvement is rare. Granulomatous inflammation may be seen in the (1) mucosa and submucosal layers, leading to erosion, ulceration, polypoid or mass lesion, and stricture; (2) nerves, leading to dysmotility and/or secondary achalasia; and (3) muscles; also causing dysmotility [5][6][7][8][9][10][11][12][13][14][15][16]. Clinical features of sarcoidosis include extrinsic GI tract compression due to lymphadenopathy, pancreatic involvement presenting as a mass lesion or diffuse enlargement, esophageal involvement with secondary achalasia, dysmotility, and pseudodiverticulosis, the stomach, especially the antrum, is the most common luminal GI organ to be involved in sarcoidosis, the small bowel is the least commonly involved, if the colon is involved, pathological findings are most often in the sigmoid colon and GI involvement may cause non-specific presenting symptoms: nausea, vomiting, weight loss, GI bleeding, abdominal pain, obstructive symptoms, protein losing enteropathy, malabsorption, diarrhea, etc.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal Sarcoidosis and Gastric Melanosis (Video)

Tang

Bhaijee

2014

Video Journal and Encyclopedia of GI Endoscopy

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Background: Sarcoidosis is a multisystem non-caseating granulomatous disease, which commonly affects the skin, joints, heart, and nervous system. Gastrointestinal sarcoidosis is rare. Likewise, only a few cases of gastric melanosis and pseudomelanosis have been reported.Patient and methods: In this video manuscript, the authors demonstrate endoscopic and pathological findings of gastrointestinal sarcoidosis and gastric melanosis in a 53-year-old African American woman with known systemic sarcoidosis who presented with recurrent gastrointestinal bleeding. Conclusions:Internists and gastroenterologists need to be aware of potential gastrointestinal involvement in patients with sarcoidosis. Gastric melanosis is very rare and has unknown clinical significance or implications.

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Upper Gastrointestinal Sarcoidosis: Report of Three Cases

Cited by 19 publications

References 9 publications

Efficacy of additional treatment with azathioprine in a patient with prednisolone-dependent gastric sarcoidosis

Efficacy of additional treatment with azathioprine in a patient with prednisolone-dependent gastric sarcoidosis

Disseminated sarcoidosis: pulmonary, endobronchial and gastric

Gastrointestinal Sarcoidosis and Gastric Melanosis (Video)

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