Published online Dec 21, 2016. doi: 10.3748/wjg.v22.i47.10471
Peer-review started: July 28, 2016
First decision: October 11, 2016
Revised: October 17, 2016
Accepted: October 27, 2016
Article in press: October 27, 2016
Published online: December 21, 2016
Gastric sarcoidosis with noncaseating granuloma is rare. Although corticosteroid produces a dramatic clinical response, it is unknown whether azathioprine show efficacy in prednisolone-dependent cases. Here, we report a case of gastric sarcoidosis in a 25-year-old man with severe epigastlargia. Gastroendoscopy revealed multiple map-like ulcerations. Histological examination showed multiple noncaseating granulomatous lesions in gastric mucosa, which were incompatible with diagnoses of Crohn’s disease or tuberculosis. He was started on prednisolone at 30 mg/d, and his symptoms improved within 7-d. The prednisolone was gradually tapered by 5 mg every 2-wk, but oral azathioprine at 50 mg was added after symptoms recurred at tapered dose of 10 mg. Endoscopy 4-wk later showed healing ulcers, and, lymphocytic infiltration was absent. The efficacy of additional azathioprine in gastric sarcoidosis is not well defined. Here, we report a case of prednisolone-dependent gastric sarcoidosis that improved after additional azathioprine, and also review the literature concerning the treatment, especially for prednisolone-dependent cases.
Core tip: Gastric sarcoidosis is often difficult to detect because of the relative lack of symptoms. Although the abdominal symptoms and endoscopic findings improve in most gastric sarcoidosis cases after corticosteroids, additional therapy, azathioprine, may be required to improve symptoms and to decrease the dosage of prednisolone.