Chlumský J, Krtek V, Chlumská A
Hepatogastroenterology. 1985 Oct;32(5):255-7.
Previously, the diagnosis of gastric sarcoidosis was only possible in retrospect - on the basis of the histology of the excised part of the stomach, since most patients with a suspected malignancy of the stomach or ulcerative haemorrhages underwent surgery. The diagnosis was verified by a positive Kveim test. Contemporary possibilities of endoscopic diagnosis, together with bioptic verification, permit conservative treatment as an alternative that spares the patient a resection of the stomach. Experience with such a conservative approach is, however, as yet somewhat scanty. The authors submit the case of a 31-year-old patient, in whom sarcoidosis of the stomach - initially identified at our department during 5000 routine fibroendoscopies of the upper digestive tract - was diagnosed endoscopically and bioptically and confirmed by the Kveim test. Prednisone (30 mg a day) was administered in decreasing doses - at present, the patient is on a maintenance dose of 5 mg a day. His digestive complaints quickly disappeared, he gained weight and returned to his job. Objectively, too, the macroscopic changes in the gastric mucosa regressed, although granulomas persist to a lesser extent in biopsy findings. With conservative treatment regular endoscopic and biopsy checkups are essential.
以前，胃结节病的诊断只能在事后进行——基于切除的胃组织部分的组织学检查，因为大多数疑似胃癌或溃疡性出血的患者都接受了手术。通过阳性的克维姆试验来证实诊断。当代的内镜诊断方法以及活检验证，使得保守治疗成为一种替代方案，从而使患者无需进行胃切除术。然而，这种保守方法的经验目前还比较少。作者报告了一名31岁患者的病例，该患者的胃结节病——最初是在我们科室对上消化道进行的5000次常规纤维内镜检查中发现的——通过内镜和活检得以诊断，并经克维姆试验证实。给予泼尼松（每日30毫克）并逐渐减量——目前，患者的维持剂量为每日5毫克。他的消化症状很快消失，体重增加并重返工作岗位。客观上，胃黏膜的宏观变化也有所消退，尽管活检结果中仍有程度较轻的肉芽肿存在。对于保守治疗，定期进行内镜和活检检查至关重要。
