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From questions on page 1684
This patient has sarcoidosis with involvement of the stomach.
Gastroscopy showed an irregularity at the Z‐line with an odd appearance on retroversion and biopsies were indicative of granulomatous gastritis. Blood tests, including serum angiotensin converting enzyme, were normal. Widespread lymphadenopathy as well as pulmonary nodules were noted at CT scan and a cervical lymph node biopsy showed non‐caseating granulomata consistent with a diagnosis of sarcoidosis. His chest symptoms and lymphadenopathy responded to treatment with prednisolone and gastrointestinal haemorrhage has not recurred.
The differential diagnosis of granulomatous gastritis includes sarcoidosis, tuberculosis, Crohn's disease, histoplasmosis, syphilis, underlying malignancy, vasculitis or a foreign body reaction. Symptomatic gastrointestinal sarcoidosis is uncommon and usually occurs in the context of established sarcoid or as a result of disseminated disease. The commonest site is gastric, though involvement of the oesophagus, small bowel and colon have also been reported. Gastric sarcoid may present with epigastric pain, vomiting, weight loss and haemorrhage, and endoscopic appearances include localised or diffuse hyperaemia, ulceration, atrophic gastritis and mucosal thickening. Corticosteroids are the first‐line treatment for symptomatic sarcoidosis.