Liver-test abnormalities in sarcoidosis

Background Sarcoidosis is a multisystemic inflammatory granulomatous disease. The prevalence of hepatic involvement is not clear. Aim The aim of this study was to establish the presence and severity of the liver-test abnormalities in sarcoidosis. Methods Retrospectively, patients with confirmed sarcoidosis (n = 837) presented with the liver-test abnormalities [alkaline phosphatase, gamma-glutamyl transaminase, alanine aminotransferase or aspartate aminotransferase > 1.5 times the upper limit of normal (ULN)] who were classified according to severity into mild (zero liver tests >= 3 x ULN), moderate (one or two liver tests >= 3 x ULN) and severe (three or four liver tests >= 3 x ULN) were evaluated. Moreover, the relationship between severity of liver tests and histology was examined. Results Liver-test abnormalities were found in 204 of 837 patients with chronic sarcoidosis (24.4%), among which 127 (15.2%) were suspected of having hepatic sarcoidosis (79 of 127 males, 111 Caucasian, eight African-American). In 22 of 127 patients (17.3%), a liver biopsy was obtained; 21 were compatible with hepatic sarcoidosis. In these 21 patients, severity of liver-test abnormalities was significantly associated with extensiveness of granulomatous inflammation (rho = 0.58, P = 0.006) and degree of fibrosis (rho = 0.64, P = 0.002). These results remained in the multiple regression analysis when controlled for treatment status, sex, genetics, ethnicity and age. Conclusion Liver-test abnormalities were present in 24% of the studied patients; in 15% highly because of hepatic involvement of sarcoidosis. Moderate and severe liver-test abnormalities seemed to be associated with more advanced histopathological disease. Therefore, in the management of sarcoidosis, for patients with moderate or severe liver-test abnormalities a liver biopsy is recommended. Eur J Gastroenterol Hepatol 24:17-24 (C) 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.