2738 A Rare Cause of Dyspepsia: Gastric Sarcoidosis

Abstract

INTRODUCTION: Dyspepsia is one of the most commonly addressed gastrointestinal problems in the outpatient settings, globally thought to affect 7-45% of the population. The majority of cases with dyspepsia are functional, as defined by the Rome Criteria, and have no organic cause. A rare cause of organic dyspepsia is gastric sarcoidosis, with only 40-60 cases described in literature so far. We present a case of new onset dyspepsia secondary to sarcoidosis. CASE DESCRIPTION/METHODS: Our patient was a 48 year-old African American female with a history of pulmonary sarcoidosis, which had been treated with systemic steroids and methotrexate and had been stable off medications. During a routine healthcare visit, she reported new onset of nausea and heartburn for one month, failed trial of PPI and then was referred for an EGD. Endoscopy showed grade A gastro-esophageal junction esophagitis and erosive gastritis. Biopsies of gastric antrum and body showed severe active chronic gastritis with non-necrotizing granulomatous inflammation, with negative staining for fungi, mycobacteria and H pylori, diagnosed as gastric sarcoidosis. DISCUSSION: Dyspepsia is a constellation of upper GI symptoms, including the presence of upper abdominal pain or discomfort with or without other symptoms such as nausea, belching and vomiting. Less than 30% of cases of dyspepsia are found to have an organic cause, the most common of which are chronic peptic ulcer disease, gastroesophageal reflux (with or without esophagitis) and malignancy. Among the rarer causes is sarcoidosis. Sarcoidosis is a multi-systemic disease characterized by the histological presence of non-caseating granulomas, which commonly has pulmonary manifestations. Gastrointestinal involvement is extremely uncommon in sarcoidosis and usually asymptomatic, with only 0.1-0.9% of all cases of GI sarcoidosis displaying symptoms. The mainstay of diagnosis is endoscopy with biopsy showing the characteristic non-caseating lesions, after ruling out infections and other etiology. Management consists of immunosuppressive therapy, including corticosteroids. Although rare, it remains the second most common cause of granulomatous gastritis in developed countries and should be kept in mind investigating GI symptoms especially in patients with preexisting disease. Our case also highlights the importance of appropriate upper endoscopy evaluation in cases of new-onset dyspepsia.