Increased Incidence of Upper and Lower Gastrointestinal Events in Patients with Sarcoidosis: A Population-Based Cohort Study

Background/Purpose:   An increased incidence of gastrointestinal (GI) events has been observed in patients with autoimmune diseases such as rheumatoid arthritis.  However, there is little information about GI complications among patients with sarcoidosis.

Methods: 345 patients (50% female; 90% Caucasian, 5% African-American; mean age 45.6 years) with incident sarcoidosis in 1976-2013 in a geographically well-defined population were identified based on comprehensive individual medical record review. Inclusion to this cohort required physician diagnosis supported by histopathology, compatible clinical presentation, and exclusion of other causes of granulomatous inflammation. A total of 345 sex and age-matched comparators (50% female; 95% Caucasian, 1% African-American; mean age 45.4 years) were also identified from the same underlying population. Medical records of both cases and comparators were individually reviewed for upper and lower GI events.  Upper GI events included ulcer, hemorrhage, perforation, obstruction, esophagitis and esophageal varices.   Lower GI events included ulcer, hemorrhage, perforation, obstruction, colitis and inflammatory bowel disease.  The cumulative incidence of all and individual GI events adjusted for the competing risk of death was estimated. Cox proportional hazards models with adjustment for age, sex, and calendar year were used to compare the rate of development of GI events, individually and in combination, between cases and comparators.  

Results: A total of 101 patients with sarcoidosis and 63 comparators developed GI events after index date during a median follow-up of 13.6 years among patients with sarcoidosis and 15.9 years among comparators. After adjusting for age, sex and calendar year, the risk of GI events after index date was significantly higher among patients with sarcoidosis with adjusted hazard ratio (HR) of 1.90 (95% confidence interval (CI), 1.38 – 2.61).  The risk was increased for both upper GI events (HR 1.90; 95% CI, 1.27 – 2.83) and lower GI events (HR 1.97; 95% CI, 1.27 – 3.05).  Analysis by individual GI event revealed a significantly increased risk of upper GI hemorrhage, upper GI ulcer and diverticulitis as shown in table 1.

Conclusion: This first ever population-based evaluation of GI events in sarcoidosis revealed that patients with this disease have a significantly increased risk of events affecting the upper and lower GI tracts.

Table 1: Hazard ratio of GI events after index date, comparing patients with sarcoidosis with subjects without sarcoidosis