Gastric sarcoidosis mimicking irritable bowel syndrome--cause not association?

Abstract

Sarcoidosis is a systemic disease of unknown aetiology that may affect any organ in the body. The gastrointestinal tract however is only rarely affected outside the liver. Symptoms may be non-specific. Irritable bowel syndrome (IBS) is a common diagnosis. The recognition of IBS is aided by the use of the Rome II criteria - in the absence of organic disease. We describe the first case of a patient with gastric sarcoidosis who presented with IBS symptoms but subsequently responded to immunosuppressive therapy.

Figure 1

Gastric antrum viewed from mid body of stomach showing widespread erythematous changes consistent with gastritis.

Figure 2

Gastro-oesophageal junction showing polypoid lesion.

Figure 3

Gastric antral biopsy (HE x 400 magnification) showing surface epithelium on the left of the image. The glands are displaced by a central granuloma formed from loosely aggregated epithelioid histiocytes, with a few surrounding lymphocytes.

Figure 4

Biopsy of polypoid lesion at gastro-oesophageal junction showing glandular tissue with active chronic inflammation and reactive epithlelial changes (HE x 200 magnification).