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home - Miscellaneous - Other - GI sarcoidosis Written by Dr Sebastian Zeki

Defines the pathophysiology of fluid and nutrient malabsorption,
including causes, e.g. anatomical and functional short bowel
syndrome, high output stomas, enterocutaneous fistulae and
pancreatic insufficiency

Knows how to investigate patients with malabsorption
Describes the clinical consequences of malabsorption, including
malnutrition, fluid and electrolyte disturbance and micronutrient
deficiency and anaemia and how to manage these

Describes all other causes of anaemia, including bone marrow
disorders and haemolysis

Describes the metabolism, absorption and bioavailability of iron, B12
and folate and clinical conditions and diets associated with their

Identifies and appropriately investigates clinical features suggestive of

Manages fluid, electrolyte and micronutrient disturbances associated
with short bowel syndrome or high output stomas

Uses the appropriate investigations for the different types of anaemia
Takes a careful clinical approach to managing patients with
malabsorption and anaemia. Explains plan of management clearly to
patients and their relatives.



Knows the different causes of enteric dysmotility (myopathy and
neuropathy) and their presenting features

Have a knowledge of scleroderma amyloid and congenital motor
abnormalities of the gut that affect absorption

Knows the principles of investigation pain relief and prokinetic drug

Understands bacterial overgrowth and its treatment
Understands how emotional status can affect gut function
Knows how diabetic complications can affect the gut
Can determine when organic obstruction is occurring TO
Can understand the principles and interpret the results of
gastrointestinal motility investigations (including manometry transit
studies etc) and autonomic function tests
Advises on appropriate prokinetic drugs and analgesics
Can detect and treat bacterial overgrowth
Advises on appropriate surgery including bypass procedures
Can relieve symptoms while not causing/risking harm with other
medications (e g opiates)

Works with the multidisciplinary NST psychiatrists/psychologists
surgeons and the pain management team

Can give careful explanation of the problems to the patient carers
friends and family

GI sarcoidosis

Gastrointestinal sarcoidosis (noncaseating granulomas)GI involved in 0.9% of sarcoidosisStomach most commonly involved PresentationGastric outlet obstructionPeptic ulcerationWeight loss Small Bowel sarcoidosisThis is very rare.It has multi-system involvement in 50%. Enteroscopy and small bowel biopsy should be considered in any patient with sarcoidosis and persistent diarrhea. Colonic sarcoidosisThis is very rare.It is usually diagnosed by rectal biopsy. Crohn's disease:Coexistance very rare.The duodenum, jejunum, and ileum are usually involved in Crohn's disease with concurrent sarcoidosis.Ulcerative colitis: More commonly associated than with Crohn’s but probably independentGI autoimmunity — 40% sarcoidosis have serological evidence of gastric autoimmunity and gluten-associated immune reactivity, however, the incidence of pernicious anemia or celiac disease in patients with sarcoidosis remains low. Pancreatic sarcoidosisThis is rare.It is more common in females.60% present with acute abdominal pain.75% have bilateral hilar NL.The patients may have a mass on USS/CT but the nature of mass cant be discerned.Confirm masses by biopsy.80% improve with steroids Hepatic sarcoidosisThe liver is always involved in GI sarcoidosis.This usually only presents with biochemical abnormalities Peritoneal SarcoidosisThis is very rare- usually with lymphocytic fluid. Endoscopy:Nodules (most common)PolypsGastritisThickened mucosa- can look like linitis plasticaBenign or malignant-appearing ulcers Treatment:Steroids and monitor with serum ACE.PPIs can be ueful for related dyspepsia. Diagnosis: AppendicealVery rare. F>M Presentation Diagnosis Treatment: Gastric Coexistence with IBD: Written by Dr Sebastian Zeki