Evidence of gastrointestinal immune reactivity in patients with sarcoidosis

Objectives, The aim of the present study was to explore the frequency of cl inical and serological manifestations of gastrointestinal immune reactivity in a large group of Swedish patients with sarcoidosis. Design. In patients with documented sarcoidosis, the presence of pernicious anaemia and coeliac disease was examined. Antibodies to H+/K+ ATPase, glia din (AGA-IgA/IgG) and endomysium (IgA-EMA) were analysed. In H+/K+ ATPase a ntibody-positive patients, serum gastrin levels were measured and, when ele vated, gastrointestinal biopsy was offered (biopsy performed in 6/9 patient s); biopsy was also offered to those with positive EMA or AGA of either cla ss (biopsy performed in 8/12 patients). Subjects from national and local st udies were used as controls. Setting. The patients were recruited at the Department of Pulmonary Medicin e, and the study was conducted at the Department of Endocrinology, Universi ty of Lund, Malmo University Hospital, Malmo, Sweden, Subjects. Of all patients (n = 89) with documented sarcoidosis attending th e Department of Pulmonary Medicine between January 1980 and December 1991, 78 [34 females and 44 males; median age at the time of the study, 48 (range 22-81) years; median observation time since the diagnosis of sarcoidosis, 120 (range 1-468) months] were examined. Results. Twenty-nine patients (37.2%) had signs of gastrointestinal immune reactivity. H+/K+ ATPase antibodies were detected in 19 patients (24.4 vs. 4% in controls, P = 0.00015). Serum gastrin levels (median 45, range 22-720 pmol L-1) in those patients correlated with antibody titre (r(2) = 0.882). Gliadin antibodies were detected in 12 patients (15.4 vs. 8.1% in controls , P = 0.042), of whom 11 (14.1 vs. 4.5% in controls, P = 0.00114) had AGA-I gA alone. One patient had pernicious anaemia and another coeliac disease (E MA-positive). Conclusion. We have demonstrated a high frequency of gastric autoimmunity a nd gluten-associated immune reactivity in patients with sarcoidosis, occurr ing in almost 40% of the cases, the former being the most frequent gastroin testinal immune manifestation, Despite a high frequency of humoral autoimmu nity, the frequencies of clinical disease, pernicious anaemia and coeliac d isease were not increased as compared with the control population.