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.