Gastric Sarcoidosis Masquerading as Gastroesophageal Reflux Disease: A Case of Diagnostic Uncertainty and Conservative Management

Background:Sarcoidosis, a rare multisystem disease characterized by non-caseating granulomas, affects the gastrointestinal system in less than 1% of cases, mainly involving the gastric antrum.Most cases are asymptomatic and are discovered incidentally during endoscopy; fewer than 1% of patients present with symptoms such as gastroesophageal reflux disease (GERD), dyspepsia, or bleeding.The relationship between gastric sarcoidosis and GERD is not well understood, posing diagnostic and treatment challenges that are not fully addressed in the current literature.This report describes a case of incidentally discovered gastric sarcoidosis presenting as GERD that improved without immunosuppressive therapy.To facilitate management, we propose an algorithm for managing GERD symptoms in the context of gastric sarcoidosis. Case Report:A 48-year-old man with pulmonary sarcoidosis -in remission for 7 years -presented for endoscopic evaluation of GERD and nonspecific chest pain.Vital signs, physical examination, and routine laboratory results, including a cardiac workup, were unremarkable.Upper gastrointestinal endoscopy revealed grade A esophagitis and a 6-mm antral papule.Histopathologic examination of the biopsy specimen revealed non-caseating granulomas consistent with gastric sarcoidosis.The patient's symptoms improved with escalated proton pump inhibitor therapy; immunosuppression was not required.Rheumatology consultation recommended no additional treatment, given his clinically quiescent disease and improvement in GERD symptoms. Conclusions:This case highlights the diagnostic uncertainty of GERD in the presence of gastric sarcoidosis and emphasizes the importance of personalized, multidisciplinary management.