Pharmaceuticals (Aug 2024)

Gastrointestinal Manifestations of Sarcoidosis: A State-of-the-Art, Comprehensive Review of the Literature—Practical Clinical Insights and Many Unmet Needs on Diagnosis and Treatment

  • Salvatore Nicolosi,
  • Maria Chernovsky,
  • Darina Angoni,
  • Michael Hughes,
  • Giulia Bandini,
  • Zsuzsanna McMahan,
  • Marta Maggisano,
  • Francesco Salton,
  • Lucrezia Mondini,
  • Mariangela Barbieri,
  • Gianluca Screm,
  • Marco Confalonieri,
  • Elisa Baratella,
  • Paola Confalonieri,
  • Barbara Ruaro

DOI
https://doi.org/10.3390/ph17091106
Journal volume & issue
Vol. 17, no. 9
p. 1106

Abstract

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This comprehensive literature review explores the involvement of the gastrointestinal (GI) tract in sarcoidosis, a multisystem granulomatous disorder of unknown etiology. GI sarcoidosis presents a diagnostic and therapeutic challenge due to its rarity and nonspecific clinical manifestations, including overlap with other gastrointestinal diseases. We conducted a comprehensive screening of articles addressing the clinical features, diagnostic approaches, and treatment strategies for GI sarcoidosis. Our findings reveal that GI sarcoidosis can affect any part of the gastrointestinal tract, with the stomach and small intestine being the most involved. Clinical presentations range from asymptomatic cases to severe complications such as obstruction and perforation, with reflux being a common symptom. Diagnosis is often delayed due to the nonspecific nature of symptoms and the need for histopathological confirmation. Therapeutic approaches are poorly defined, typically involving corticosteroids as the mainstay of treatment. However, the long-term efficacy and safety of these treatments remain uncertain in this patient group, given the significant risks and complications associated with prolonged glucocorticoid therapy. There is a clear need to develop accurate diagnostic protocols to distinguish GI sarcoidosis from other conditions and to establish standardized therapeutic guidelines to optimize patient outcomes. Further research is essential to enhance our understanding and management of this complex condition.

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