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.