Weight loss and digestive symptoms such as nausea, vomiting, diarrhea, and digestive bleeding could be linked to digestive tract sarcoidosis (DTS), especially in patients of African and Afro-Caribbean origin, according to a study conducted by researchers in France. DTS should therefore be considered in the presence of these symptoms, and in every patient with digestive granulomatosis.
The team analyzed 25 patients with DTS (more than 50 percent of whom were of African or Afro-Caribbean origin), and compared the characteristics of the disease with 50 patients with non-digestive tract sarcoidosis, and 100 controls with Crohn’s disease (an inflammatory bowel disease).
Researchers found that people with DTS had no swollen lymph nodes in their chest, but instead had lesions mainly in the stomach and also in the colon, rectum, and, to a lesser extent, in the esophagus and in the duodenum (the first section of the small intestine).
Even though sarcoidosis mainly affects lungs and chest lymph nodes, in very rare cases (01 percent to 1.6 percent) it can also involve the digestive tract. Because the presence of granulomas in the digestive system is mainly associated with Crohn’s disease, the researchers compared DTS with Crohn’s disease to determine the characteristics that could differentiate these two conditions.
The team found that DTS more often involved the upper digestive tract, especially the stomach, while patients with Crohn’s disease more often had lesions in the ileum (the final section of the small intestine), and the colon. In addition, patients with DTS often had other complications, such as interstitial lung disease, swollen lymph nodes, granulomatous hepatitis, high calcium levels in the blood, and central nervous system or heart involvement, which are not typically seen in Crohn’s disease.
Interestingly, DTS was more frequently observed in African or Afro-Caribbean patients compared to Crohn’s disease.
“The absence of ileal or colonic involvement in a patient with a granulomatous digestive tract disease, especially with an African or Afro-Caribbean origin, must encourage considering the diagnosis of sarcoidosis,” the research team wrote in their report.
In the last follow-up assessment performed, 76 percent of the patients with DTS recovered by themselves (clinical digestive remission) and did not need surgery, while a third of the patients with Crohn’s disease did require a surgical intervention.
“The differential diagnosis with Crohn’s disease could be an issue with DTS. Nevertheless, the two diseases often have different clinical presentation and outcome,” the research team concluded.
The study, “Digestive-tract sarcoidosis: French nationwide case–control study of 25 cases,” was published in the journal Medicine.