Gastrointestinal sarcoidosis: radiographic findings

Sarcoidosis is a systemic granulomatous disease of unknown origin. It is manifested pathologically by the presence of noncaseating granulomas containing multinucleated giant cells, although other granulomatous diseases may produce identical findings. The vast majority of patients have thoracic sarcoidosis with bilateral hilar lymphadenopathy and/or fibronodular pulmonary infiltrates on chest radiographs. About 40% of patients have extrathoracic disease involving the eye, skin, lymph nodes, liver, spleen, heart, and musculoskeletal or nervous system. Although sarcoidosis is rarely thought to affect the gastrointestinal (GI) tract, one investigator found noncaseating granulomas on mucosal biopsies of the stomach in 1 0% of patients with known sarcoidosis [1]. Thus, GI involvement by this disease may be more common than generally is recognized. In sporadic reports, conventional single-contrast barium studies performed on patients with gastric sarcoidosis have shown gastric ulceration and narrowing due to granulomatous infiltration of the wall [2-5]. However, we report two patients with gastric sarcoidosis in whom double-contrast upper GI examinations revealed superficial mucosal abnormalities prior to the development of significant intramural disease. We also report one patient with an annular, obstructing lesion in the colon due to sarcoidosis.