Sarcoidosis of the stomach. Endoscopic diagnosis and possibilities of conservative treatment.

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.