Multinational Survey on the Symptom Approach to Diagnosis and Therapy Adopted by Physicians in the Treatment of Gastrointestinal Sarcoidosis.

Background

Gastrointestinal (GI) sarcoidosis is a rare manifestation of systemic disease, with limited evidence to guide diagnosis and treatment.

Methods

A 75-item international survey was completed by 132 clinicians from multiple specialties and hospital settings. Statistical analysis was performed using Jamovi version 2.6.44 (The Jamovi Project, Sydney, Australia).

Results

Most clinicians (72.0%) preferred a comprehensive diagnostic approach integrating clinical, imaging and histopathological assessment, with differences by hospital type (p < 0.05). Inflammatory bowel disease was frequently considered in the differential diagnosis, and concern regarding excluding inflammatory conditions remained consistently high. Significant specialty-related variation was observed for specific organ involvement and in the management of glucocorticoid-refractory disease, including use of alternative immunosuppressants, combination regimens, glucocorticoid-sparing agents, and biologic therapies. Expectations regarding response timelines and indications for surgery were largely concordant.

Conclusions

Clinicians reported high awareness but heterogeneous management practices for GI sarcoidosis, particularly beyond first-line glucocorticoids. These findings highlight the need for multidisciplinary consensus and the development of standardized clinical guidelines.