Hepatobiliary disease in sarcoidosis.

BACKGROUND AND AIM: Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Little is known about the prevalence, pattern, and risk factors for hepatobiliary disease in patients with sarcoidosis.

METHODS

We retrieved the records of all patients diagnosed with sarcoidosis at a tertiary care referral hospital and a county hospital between 1976 and 2002. Liver disease was defined as abnormal liver tests (AST > 45 U/L, ALT > 35 U/L, alkaline phosphatase > 125 U/L, total bilirubin > 1.3 mg/dL) in the setting of sarcoidosis. Patients with sarcoidosis and normal liver tests constituted a comparison group.

RESULTS

A total of 1,436 patients with presumed sarcoidosis were identified (66% female, 57% African-American). Three hundred and forty patients had abnormalities in liver tests, and 40 with confirmed sarcoidosis underwent a liver biopsy. Biopsy specimens were available for review for 34 patients; 29 (85%) of 34 exhibited various degrees of portal inflammation, bile duct depletion was noted in 17 (50%), and 9 (26%) had bridging fibrosis or cirrhosis. One hundred and thirty patients with sarcoidosis and normal liver tests were compared to the 40 with sarcoid-related hepatic dysfunction. Male gender, hepatomegaly, splenomegaly, and normal chest radiograph were associated with hepatic sarcoidosis. On multivariate analysis, male gender (OR 2.8, p = 0.012), and splenomegaly (OR 9.2, p < 0.0001) were more prevalent in the group with liver disease.

CONCLUSIONS

Hepatobiliary disease in sarcoidosis is rarely clinically overt. When present, it ranges from asymptomatic liver tests abnormalities to cirrhosis. Male gender and splenomegaly were significantly associated with sarcoid-related liver disease.