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Nicolosi S, Chernovsky M, Angoni D, Hughes M, Bandini G, McMahan Z, Maggisano M, Salton F, Mondini L, Barbieri M, Screm G, Confalonieri M, Baratella E, Confalonieri P, Ruaro B. Gastrointestinal Manifestations of Sarcoidosis: A State-of-the-Art, Comprehensive Review of the Literature-Practical Clinical Insights and Many Unmet Needs on Diagnosis and Treatment. Pharmaceuticals (Basel) 2024; 17:1106. [PMID: 39338270 PMCID: PMC11435091 DOI: 10.3390/ph17091106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/17/2024] [Accepted: 08/20/2024] [Indexed: 09/30/2024] Open
Abstract
This comprehensive literature review explores the involvement of the gastrointestinal (GI) tract in sarcoidosis, a multisystem granulomatous disorder of unknown etiology. GI sarcoidosis presents a diagnostic and therapeutic challenge due to its rarity and nonspecific clinical manifestations, including overlap with other gastrointestinal diseases. We conducted a comprehensive screening of articles addressing the clinical features, diagnostic approaches, and treatment strategies for GI sarcoidosis. Our findings reveal that GI sarcoidosis can affect any part of the gastrointestinal tract, with the stomach and small intestine being the most involved. Clinical presentations range from asymptomatic cases to severe complications such as obstruction and perforation, with reflux being a common symptom. Diagnosis is often delayed due to the nonspecific nature of symptoms and the need for histopathological confirmation. Therapeutic approaches are poorly defined, typically involving corticosteroids as the mainstay of treatment. However, the long-term efficacy and safety of these treatments remain uncertain in this patient group, given the significant risks and complications associated with prolonged glucocorticoid therapy. There is a clear need to develop accurate diagnostic protocols to distinguish GI sarcoidosis from other conditions and to establish standardized therapeutic guidelines to optimize patient outcomes. Further research is essential to enhance our understanding and management of this complex condition.
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Affiliation(s)
- Salvatore Nicolosi
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy (D.A.); (M.M.)
| | - Maria Chernovsky
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy (D.A.); (M.M.)
| | - Darina Angoni
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy (D.A.); (M.M.)
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
| | - Giulia Bandini
- Department of Experimental and Clinical Medicine, Division of Internal Medicine, Azienda Ospedaliero Universitaria Careggi, University of Florence, 50134 Florence, Italy;
| | - Zsuzsanna McMahan
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Marta Maggisano
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy (D.A.); (M.M.)
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy (D.A.); (M.M.)
| | - Lucrezia Mondini
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy (D.A.); (M.M.)
| | - Mariangela Barbieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy (D.A.); (M.M.)
| | - Gianluca Screm
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy (D.A.); (M.M.)
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy (D.A.); (M.M.)
| | - Elisa Baratella
- Radiology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, 34149 Trieste, Italy
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy (D.A.); (M.M.)
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy (D.A.); (M.M.)
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Rugge M, Genta RM, Malfertheiner P, Dinis-Ribeiro M, El-Serag H, Graham DY, Kuipers EJ, Leung WK, Park JY, Rokkas T, Schulz C, El-Omar EM. RE.GA.IN.: the Real-world Gastritis Initiative-updating the updates. Gut 2024; 73:407-441. [PMID: 38383142 DOI: 10.1136/gutjnl-2023-331164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/18/2023] [Indexed: 02/23/2024]
Abstract
At the end of the last century, a far-sighted 'working party' held in Sydney, Australia addressed the clinicopathological issues related to gastric inflammatory diseases. A few years later, an international conference held in Houston, Texas, USA critically updated the seminal Sydney classification. In line with these initiatives, Kyoto Global Consensus Report, flanked by the Maastricht-Florence conferences, added new clinical evidence to the gastritis clinicopathological puzzle.The most relevant topics related to the gastric inflammatory diseases have been addressed by the Real-world Gastritis Initiative (RE.GA.IN.), from disease definitions to the clinical diagnosis and prognosis. This paper reports the conclusions of the RE.GA.IN. consensus process, which culminated in Venice in November 2022 after more than 8 months of intense global scientific deliberations. A forum of gastritis scholars from five continents participated in the multidisciplinary RE.GA.IN. consensus. After lively debates on the most controversial aspects of the gastritis spectrum, the RE.GA.IN. Faculty amalgamated complementary knowledge to distil patient-centred, evidence-based statements to assist health professionals in their real-world clinical practice. The sections of this report focus on: the epidemiology of gastritis; Helicobacter pylori as dominant aetiology of environmental gastritis and as the most important determinant of the gastric oncogenetic field; the evolving knowledge on gastric autoimmunity; the clinicopathological relevance of gastric microbiota; the new diagnostic horizons of endoscopy; and the clinical priority of histologically reporting gastritis in terms of staging. The ultimate goal of RE.GA.IN. was and remains the promotion of further improvement in the clinical management of patients with gastritis.
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Affiliation(s)
- Massimo Rugge
- Department of Medicine-DIMED, University of Padova, Padua, Italy
- Azienda Zero, Veneto Tumour Registry, Padua, Italy
| | - Robert M Genta
- Gastrointestinal Pathology, Inform Diagnostics Research Institute, Dallas, Texas, USA
- Pathology, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Malfertheiner
- Medizinische Klinik und Poliklinik II, Ludwig Maximilian Universität Klinikum München, Munich, Germany
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany
| | - Mario Dinis-Ribeiro
- Porto Comprehensive Cancer Center & RISE@CI-IPO, University of Porto, Porto, Portugal
- Gastroenterology Department, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - Hashem El-Serag
- Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
- Houston VA Health Services Research & Development Center of Excellence, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - David Y Graham
- Department of Medicine, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Ernst J Kuipers
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Jin Young Park
- International Agency for Research on Cancer, Lyon, France
| | - Theodore Rokkas
- Gastroenterology, Henry Dunant Hospital Center, Athens, Greece
| | | | - Emad M El-Omar
- Microbiome Research Centre, University of New South Wales, Sydney, New South Wales, Australia
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Shah N, Mitra A. Gastrointestinal and Hepatic Sarcoidosis: A Review Article. Clin Liver Dis (Hoboken) 2021; 17:301-307. [PMID: 33968393 PMCID: PMC8087901 DOI: 10.1002/cld.1055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/24/2020] [Accepted: 10/11/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Neil Shah
- Division of Internal MedicineDepartment of MedicineOregon Health & Science UniversityPortlandOR
| | - Arnab Mitra
- Division of Gastroenterology and HepatologyOregon Health & Science UniversityPortlandOR
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Gastric sarcoidosis: Rare revealing feature of systemic sarcoidosis. Arab J Gastroenterol 2020; 21:62-64. [PMID: 32115384 DOI: 10.1016/j.ajg.2020.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 12/30/2018] [Accepted: 02/02/2020] [Indexed: 11/22/2022]
Abstract
Gastric sarcoidosis is clinically manifest in less than 1% of patients with systemic disease. Stomach is the most commonly involved site. Clinical signs are non-specific. We report the case of a female patient presenting with abdominal pain with no associated symptoms. Upper gastrointestinal endoscopy showed mucosal erosions. Biopsy and histological study revealed the presence of a gastric non-caseating granuloma. No other involvement was found and infectious granulomatosis was ruled out. Patient was treated with corticosteroids with substantial improvement. One year later, the patient presented with respiratory symptoms and joint pain. Chest computed tomography showed multiple mediastinal and bilateral hilar lymphadenopathies. It also highlighted the presence of interstitial lung disease and a 1 cm pulmonary nodule. Histological examination of this nodule revealed non-caseating granuloma. Serum angiotensin converting enzyme level was elevated. Lymphocytic alveolitis was diagnosed with bronchoalveolar lavage. Systemic sarcoidosis with gastric involvement was suggested. Patient was treated with corticosteroids and developed a favourable clinical course. Isolated gastric sarcoidosis is a challenging diagnosis. Histological findings are the key to diagnosis. Other granulomatous diseases need to be excluded especially infectious diseases before establishing the diagnosis of sarcoidosis. Corticosteroids are used in treating gastric sarcoidosis, yet no guidelines exist for the treatment of this rare condition.
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Bhattarai B, Mandal A, Lamichhane J, Datar P, Mukhtar O, Alhafidh O, Lixon A, Gayam V, Enriquez D, Quist J, Schmidt F. A symptomatic gastric sarcoidosis and asymptomatic pulmonary sarcoidosis: a rare manifestation. J Community Hosp Intern Med Perspect 2019; 9:440-442. [PMID: 31723393 PMCID: PMC6830201 DOI: 10.1080/20009666.2019.1653140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/01/2019] [Indexed: 11/04/2022] Open
Abstract
Sarcoidosis is a granulomatous disease of unknown etiology which may present with systemic manifestations. The diagnosis of gastric sarcoidosis needs much effort to accomplish as it is exceedingly rare, and the treatment is usually recommended exclusively for symptomatic disease. Here, we present a case of gastric sarcoidosis in a 31-year old black female patient with symptoms of nausea and epigastric pain. A diagnosis of gastric sarcoidosis was mainly based on the presence of non-necrotizing granulomas on biopsy following esophagogastroduodenoscopy (EGD). She was treated with steroid with high dose at first, followed by a slow taper and the symptoms responded to the treatment.
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Affiliation(s)
- Bikash Bhattarai
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, USA
| | - Amrendra Mandal
- Department of Medicine, Interfaith Medical Center, Brooklyn, USA
| | - Jenny Lamichhane
- Department of Medicine, St. John’s Riverside hospital, Yonkers, NY, USA
| | - Praveen Datar
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, USA
| | - Osama Mukhtar
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, USA
| | - Oday Alhafidh
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, USA
| | - Anton Lixon
- Department of Pulmonary and sleep Medicine, NYU Winthrop, Mineola, NY, USA
| | - Vijay Gayam
- Department of Medicine, Interfaith Medical Center, Brooklyn, USA
| | - Danilo Enriquez
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, USA
| | - Joseph Quist
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, USA
| | - Frances Schmidt
- Department of Pulmonology, Interfaith Medical Center, Brooklyn, USA
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Deepa AS, Padegal VA, Chandra KSP, Santhosh HK. Gastric and pulmonary sarcoidosis complicated by hypercalcemia and acute renal failure: Case report and literature review. Lung India 2017; 34:380-382. [PMID: 28671172 PMCID: PMC5504898 DOI: 10.4103/lungindia.lungindia_276_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Gastric sarcoidosis is a very rare manifestation of sarcoidosis. Only few case reports have been described in the literature. We present a case of coexisting gastric and pulmonary sarcoidosis in a 56-year-old female, who presented with gastrointestinal symptoms. Gastric mucosal biopsies, transbronchial needle aspiration, and endobronchial mucosal biopsies revealed noncaseating granulomas. This case report emphasizes on early evaluation of other organ system and initiation of treatment.
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Affiliation(s)
- A S Deepa
- Department of Pulmonary Medicine, Gastroenterology and Radiology, Fortis Hospital, Bengaluru, Karnataka, India
| | - Vivek Anand Padegal
- Department of Pulmonary Medicine, Gastroenterology and Radiology, Fortis Hospital, Bengaluru, Karnataka, India
| | - K S Poorna Chandra
- Department of Pulmonary Medicine, Gastroenterology and Radiology, Fortis Hospital, Bengaluru, Karnataka, India
| | - H K Santhosh
- Department of Pulmonary Medicine, Gastroenterology and Radiology, Fortis Hospital, Bengaluru, Karnataka, India
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Murata M, Sugimoto M, Yokota Y, Ban H, Inatomi O, Bamba S, Kushima R, Andoh A. Efficacy of additional treatment with azathioprine in a patient with prednisolone-dependent gastric sarcoidosis. World J Gastroenterol 2016; 22:10471-10476. [PMID: 28058029 PMCID: PMC5175261 DOI: 10.3748/wjg.v22.i47.10471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/17/2016] [Accepted: 10/27/2016] [Indexed: 02/07/2023] Open
Abstract
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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Ceylan E, Şen S, Coşkun A, Meteoğlu İ, Demirtaş N, Çildağ O. Gastric involvement of sarcoidosis in a patient with multiple lung nodules. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2015; 20:525-8. [PMID: 26487882 PMCID: PMC4590208 DOI: 10.4103/1735-1995.163981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Sarcoidosis is a granulomatous disorder mostly could involve intrathoracic structures. The gastric involvement is rare and the symptoms may be non-specific. We herein report a case of a 56-year-old female patient who was admitted due to chest tightness and discomfort. Computed tomography (CT) of the thorax revealed bilaterally nodular lesions in the lower lobes of the lung and pleural effusion on the left side. Positron emission tomography/CT showed lung nodules and gastric involvement with mesenteric lymphadenomegalies with pathological uptake of 18F-fluoro-2-deoxy-d-glucose. Pathological examination of the lung biopsy taken by thoracotomy demonstrated non-caseating granulomas. The gastric biopsies taken by endoscopy also showed non-caseating granulomas consistent with a diagnosis of sarcoidosis.
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Affiliation(s)
- Emel Ceylan
- Department of Pulmonary Medicine, Adnan Menderes University, Aydin, Turkey
| | - Serdar Şen
- Department of Thoracic Surgery, Adnan Menderes University, Aydin, Turkey
| | - Adil Coşkun
- Department of Gastroenterology, Adnan Menderes University, Aydin, Turkey
| | - İbrahim Meteoğlu
- Department of Pathology, Adnan Menderes University, Aydin, Turkey
| | - Nimet Demirtaş
- Department of Pulmonary Medicine, Atatürk State Hospital, Aydin, Turkey
| | - Orhan Çildağ
- Department of Pulmonary Medicine, Adnan Menderes University, Aydin, Turkey
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Mankodi S, Planche K, Watkins J, Murray C. Malignant mimicry--a 17-year-old with abdominal pain and weight loss. Gut 2013; 62:995, 1084. [PMID: 22914297 DOI: 10.1136/gutjnl-2012-303358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- Sheena Mankodi
- Department of Gastroenterology, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
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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: 2.1] [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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Pneumothorax as a presenting feature of granulomatous disease of the lung in a patient with Crohn's disease. Eur J Gastroenterol Hepatol 2009; 21:237-40. [PMID: 19212215 DOI: 10.1097/meg.0b013e328304e0cc] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pulmonary disease and abnormalities of pulmonary function testing have been described in patients with Crohn's disease. The case of a 25-year-old female presenting with pneumothorax as a complication of Crohn's-related granulomatous lung disease is described here. The patient presented with symptoms of dyspnoea and chest pain, a chest radiograph revealed a pneumothorax on the right side. This pneumothorax did not resolve with intercostal tube drainage. Video-assisted thoracoscopy was performed at which small blebs were observed on the surface of the lung. Histology from a resected specimen of lung tissue demonstrated noncaseating granulomas. Colonoscopy was performed to investigate synchronous iron deficiency anaemia. This showed changes typical of Crohn's colitis. Granulomas were identified on histological examination of colonic tissue. Although pulmonary involvement in Crohn's disease has become increasingly recognised, pneumothorax has not been described previously.
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