Hepatic Sarcoidosis: Clinical Features, Portal Hypertension, and Treatment Outcomes in a Monocentric Cohort of 16 Patients

Background: Hepatic involvement in sarcoidosis is common but often asymptomatic. However, it can progress to severe complications such as cirrhosis and portal hypertension (PHT). This study aims to characterize the clinical, biological, histological features, and therapeutic outcomes in a monocentric cohort. Methods: We conducted a retrospective descriptive study of 16 patients followed for hepatic sarcoidosis in the gastroenterology department of a Moroccan hospital between 2017 and 2026. Diagnosis was based on liver biopsy (non-caseating granulomas), systemic evidence, and exclusion of other causes. Statistical analysis was performed using Jamovi. Results: All 16 patients were female, with a mean age of 49.1 ±13.5 years. Hepatic involvement was symptomatic in 68.7% (n=11), primarily presenting as pruritus (45.5%) and abdominal pain. Biological cholestasis was found in 81.2% (n=13), while angiotensin-converting enzyme (ACE) was elevated in 73%. Extra-hepatic involvement was present in 75% (n=12), dominated by pulmonary Stage II sarcoidosis. PHT was identified in 43.7% (n=7), with 3 patients experiencing hemorrhagic decompensation. Treatment included ursodeoxycholic acid (n=12) and/or systemic corticosteroids (n=8). A favorable biological response was significantly more frequent in treated patients (p=0.04). Despite PHT and advanced fibrosis, overall outcome remained stable over a median follow-up of 56 months. Conclusion: Hepatic sarcoidosis is a heterogeneous condition characterized by a cholestatic profile and portal granulomatous inflammation. The high prevalence of PHT (43.7%) suggests that disease severity may be underestimated. While treatment effectively improves biochemical abnormalities, the potential for severe complications necessitates rigorous long-term follow-up.