Sarcoidosis of the liver: to treat or not to treat?

Sarcoidosis is a non-caseating, granulomatous disease of incompletely understood aetiology that can affect nearly all organs including the liver. Hepatic involvement is thought to occur in 50-90% of patients but may remain undiagnosed in many cases. Evidence-based guidelines for the treatment of sar...

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Bibliographic Details
Published in:	Netherlands journal of medicine Vol. 70; no. 8; pp. 349 - 356
Main Authors:	BAKKER, G. J, HAAN, Y. C. L, MAILLETTE DE BUY WENNIGER, L. J, BEUERS, U
Format:	Journal Article
Language:	English
Published:	Alphen aan den Rijn Van zuiden 01-10-2012
Subjects:	Adrenal Cortex Hormones - therapeutic use Anti-Inflammatory Agents - therapeutic use Biological and medical sciences Cholagogues and Choleretics - therapeutic use Fatigue - etiology Female Gastroenterology. Liver. Pancreas. Abdomen General aspects Humans Liver - chemistry Liver - drug effects Liver Diseases - blood Liver Diseases - complications Liver Diseases - drug therapy Liver. Biliary tract. Portal circulation. Exocrine pancreas Male Medical sciences Middle Aged Other diseases. Semiology Prednisolone - therapeutic use Pruritus - etiology Sarcoidosis - blood Sarcoidosis - complications Sarcoidosis - drug therapy Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Treatment Outcome Ursodeoxycholic Acid - therapeutic use Medicine Treatment Sarcoidosis Digestive system cholestasis Bile acid Liver Systemic disease Cholostasis Digestive diseases Biliary tract disease Ursodeoxycholic acid
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Summary:	Sarcoidosis is a non-caseating, granulomatous disease of incompletely understood aetiology that can affect nearly all organs including the liver. Hepatic involvement is thought to occur in 50-90% of patients but may remain undiagnosed in many cases. Evidence-based guidelines for the treatment of sarcoidosis of the liver are lacking. Patients usually receive no treatment or are treated pragmatically with corticosteroids. However, treatment with systemic corticosteroids has had mixed results. The use of ursodeoxycholic acid (UDCA) in the treatment of sarcoidosis-associated cholestasis has been reported by several groups, and is empirically prescribed to sarcoidosis patients with hepatic involvement. The effect of UDCA on symptoms and serum liver tests was investigated in a retrospective cohort study in which hepatic sarcoidosis patients had received either no treatment, prednisolone treatment or UDCA treatment. For all patients, laboratory results on ASAT, ALAT, AP and GGT were collected. Patients described the severity of their symptoms before and after treatment on a numerical scale. A total of 17 patients participated in the study. Serum liver tests in the group treated with UDCA had improved as compared with the other groups. Also, symptomatic improvement of pruritus and fatigue was reported in the group treated with UDCA. This retrospective cohort study supports the empirical first-line use of UDCA in the treatment of sarcoidosis of the liver, especially in symptomatic patients. Prospective randomised trials are needed to adequately support this concept.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1
ISSN:	0300-2977 1872-9061