Case Report Associates Patient’s Swallowing Problem with Sarcoidosis

Sarcoidosis may lead to the development of diverticula (formation of small pouches in a tissue) in the esophagus, thus prompting the onset of swallowing disorders, according to a case study published in the American College of Gastroenterology (ACG) Case Reports Journal.

The report, titled “Sarcoidosis Causing Mid-Esophageal Traction Diverticulum,” was conducted by physicians from the Lincoln Medical and Mental Health Center, in Bronx, N.Y.

Sarcoidosis is characterized by the accumulation of immune system cells in multiple organs, possibly impairing their function. The symptoms of sarcoidosis usually are nonspecific and generalized, including fever, fatigue and weight loss, but symptoms vary depending on the organs affected.

The study reports the case of a 78-year-old man who was admitted to the clinic with a history of progressive dysphagia (difficulty in swallowing). The patient complained that solid foods got stuck in his chest after swallowing. The medical history of the patient included bronchial asthma, allergic rhinitis, pulmonary hypertension, and sarcoidosis.

Sarcoidosis had been diagnosed a few years before when, due to an asthma attack, the patient underwent a CT scan of his chest. The diagnosis was confirmed by analysis of a lung tissue biopsy.

During the assessment of the swallowing complaints by the patient, doctors performed an esophagram, which revealed a diverticulum in the mid-esophagus with 1.5 cm diameter. However, the patient was a poor candidate for surgery treatment.

According to the authors, this is only the second known case of the development of diverticula in the esophagus due to sarcoidosis. Although this phenomenon is rare, it can be triggered by inflammation of certain lymph nodes or by conditions, such as tuberculosis and histoplasmosis (infection with the fungus Histoplasma capsulatum).

Researchers also noted that esophageal diverticulum is usually asymptomatic and thus does not require treatment. But when patients present symptoms, surgery or endoscopic treatment may be considered, although the latter can perforate the esophagus. In cases in which these methods are not feasible, doctors advise patients to eat less solid forms to avoid swallowing difficulties.

“Clinicians should be aware of the possibility of … mid-esophageal diverticulum in sarcoidosis patients with progressive dysphagia,” the team wrote in its report. “A simple diagnostic test like an esophagram provides early diagnosis even if clinical consideration is lacking, which can avoid possible morbidity and mortality.”