2684 Gastric Sarcoidosis

Abstract

INTRODUCTION: Sarcoidosis is a systemic inflammatory disease of unclear etiology. It can involve almost any organ in the body, with pulmonary involvement being the most common. Gastrointestinal (GI) involvement is rare (0.1- 0.9% of all cases) with symptomatic gastric sarcoid, even more rare (with a handful of cases reported in the literature). We present a case of a patient who developed symptomatic gastric sarcoidosis. CASE DESCRIPTION/METHODS: A 48-year old African American male was seen in the GI clinic for a 5-year history of diffuse intermittent abdominal pain. The patient had a known diagnosis of severe sarcoidosis diagnosed 10 years ago. He had multiple organs effected including lungs (Restrictive disease on PFTs), liver (bridging fibrosis with hyalinized nodular sclerosis on the biopsy) and skin involvement (resulting in chronic pruritus treated with Plaquenil). The patient also had a history of H.pylori with multiple small clean-based ulcers in the gastric corpus and erythematous duodenopathy diagnosed on esophagogastroduodenoscopy (EGD) 11 years ago. Following that he completed the triple antibiotic regimen. The patient for the last four months reported severe periumbilical pain with several ED visits. He underwent 3 colonoscopies over the course of the last 5 years, which were unremarkable. EGD was repeated, which showed multiple nonbleeding duodenal ulcers with gastric biopsy showing non-caseating granulomas. His H.Pylori stain was negative on this occasion. At this time a diagnosis of gastric sarcoidosis was made. The patient was placed on a proton pump inhibitor with an escalation in the dose of his systemic steroids resulting in resolution of his symptoms. DISCUSSION: Most cases of gastric sarcoidosis are initially asymptomatic. The most commonly reported symptom is epigastric pain. Other symptoms include nausea, vomiting, hematemesis, melena, and weight loss. Due to the non-specific nature of these reported symptoms, making the diagnosis purely on clinical history is difficult, and a high index of suspicion is needed to make the diagnosis. Endoscopically it can present with ulceration or a diffuse linitis plastica like the involvement of stomach. Pathology is key to diagnosis and shows non- caseating granulomas. Asymptomatic patients do not require treatment though for symptomatic patients recommended treatment is a combination of proton pump inhibitors with systemic steroids. Marvin A. Chinitz et al. reported symptom improvement in 66% of gastric sarcoid patients with systemic steroids.