Symptomatic gastric sarcoidosis and Helicobacter pylori infection.

Sarcoidosis is a multiorgan granulomatous disease of undetermined cause most commonly affecting young adults and typically characterized by pulmonary infiltrates, bilateral hilar lymphadenopathy, and cutaneous and ocular lesions. l Gastric involvement is the second most common site of gastrointestinal involvement after the liver, although the overall incidence of gastric sarcoidosis is still unclear. Palmer2 found sarcoid granulomas in the biopsy specimens of 6 of 54 patients who had sarcoidosis but no gastrointestinal symptoms, suggesting an incidence of up to 10 percent; however, biopsy sampling error could have resulted in underestimating the actual frequency of the disease. 3 Nevertheless, the frequency of symptomatic gastric sarcoidosis based upon case reports might be as little as 1 percent.4 Gastric sarcoidosis results in symptoms similar to those of peptic ulcer disease,5 upper gastrointestinal hemorrhage,6-9 or gastric outlet obstruction. lO There are reports of gastric sarcoidosis being mistaken for infiltrating gastric carcinoma because of their similar clinical manifestations and the linitis plastica radiographic appearance common to both.II,12 The relation between the granulomatous mucosal changes seen in gastric sarcoidosis and in peptic ulcer development has not been extensively examined in the medical literature, particularly with regard to the recent emergence of Helicobacter pylori infection as a causative agent in peptic ulcer disease. The following case report is unusual in that it is, to our knowledge, the first case report of symptomatic gastric sarcoidosis mimicking peptic ulcer disease and confounded by Helicobacter pylori infection.