Latest news with #HelicobacterPylori
Sustainability Times
10-07-2025
- Health
- Sustainability Times
'Stop Stomach Cancer Now': This Game-Changing H. Pylori Treatment Could Be the Lifesaving Answer You've Been Waiting For
IN A NUTSHELL 🔍 Screening and treating Helicobacter pylori infections could prevent up to 75% of future stomach cancer cases. and treating infections could prevent up to 75% of future stomach cancer cases. 📈 The study projects 15.6 million new gastric cancer cases globally, with Asia bearing the highest burden. 💊 Cost-effective prevention strategies, similar to vaccination campaigns, can significantly reduce the global incidence of stomach cancer. 🌍 Tailored interventions for different income regions are crucial for effective implementation and success. Stomach cancer, a formidable health challenge, has alarmingly risen among young adults worldwide, becoming a pressing issue that warrants immediate attention. Recent research has highlighted a promising preventive measure: the targeted treatment of Helicobacter pylori (H. pylori) infections. This bacterium is a significant risk factor for gastric cancer, yet it is preventable and treatable. The study underscores the potential of screening and treating H. pylori infections to avert the majority of future stomach cancer cases, offering hope in the fight against this deadly disease. Understanding the Rise of Stomach Cancer The global incidence of stomach cancer has seen a disturbing increase, particularly among individuals under the age of 50. This trend has been linked to chronic infections with H. pylori, the most potent known risk factor for the disease. The International Agency for Research on Cancer (IARC), in collaboration with the World Health Organization (WHO), has conducted extensive research to project future trends in stomach cancer incidence. Their findings reveal that if current prevention and treatment strategies remain unchanged, around 15.6 million new cases of gastric cancer will emerge among those born between 2008 and 2017. The research highlights that a staggering 76% of these cases are attributable to H. pylori infections, suggesting that they are potentially preventable. Alarmingly, the burden is expected to be highest in Asia, with 10.6 million cases, followed by the Americas and Africa. This data underscores the urgent need for effective public health interventions to address this rising health threat. Cold Plunges Are a Scam for Women and Science Just Dropped the Mic on This Freezing Hot Fitness Fad The Role of H. Pylori in Gastric Cancer Helicobacter pylori is a bacterium that colonizes the stomach lining, leading to chronic inflammation and increasing the risk of developing stomach cancer. Despite being a major health concern, H. pylori is a preventable risk factor. The standard treatment involves antibiotics combined with proton pump inhibitors (PPIs), which reduce stomach acid production, effectively targeting the infection. Given its significant role in gastric cancer, addressing H. pylori infections presents a viable strategy to curb the disease's incidence. The study suggests that comprehensive screening and treatment programs could potentially reduce stomach cancer cases by up to 75%. Even partially effective programs, achieving 80% to 90% efficacy, could prevent 60% to 68% of cases, demonstrating the immense potential of such interventions. « This brewing habit could silently hurt you »: these common coffee preparation methods directly linked to increased heart disease risk Implementing Effective Prevention Strategies The implementation of a H. pylori screening and treatment program requires strategic planning and investment. Researchers advocate for population-based interventions, tailored to the economic realities of different regions. In high-income countries, endoscopy-based screening and insurance-supported treatments could be effective, while in lower-income regions, population-level screening and early treatment could be more feasible and impactful. These strategies are cost-effective, akin to vaccination campaigns for HPV or hepatitis B, and could significantly reduce the global burden of stomach cancer. The study stresses the importance of developing an H. pylori vaccine, which could further revolutionize prevention efforts, offering a long-term solution to this global health challenge. 'Your Breath Is a Signature': Scientists Reveal Human Breath Is as Unique and Traceable as a Fingerprint Addressing Challenges and Moving Forward Despite the promising nature of the findings, the study acknowledges several limitations. Many low-income countries lack comprehensive cancer registries, potentially leading to data underestimation. Moreover, assumptions about the constancy of H. pylori prevalence and cancer incidence rates could affect the accuracy of projections. Nonetheless, the research provides a compelling case for increased investment in gastric cancer prevention. By prioritizing the eradication of H. pylori, public health systems can significantly reduce the incidence of stomach cancer. The study advocates for targeted, evidence-based interventions that consider demographic trends and regional disparities. As scientists and policymakers collaborate to tackle this issue, the potential to save millions of lives becomes increasingly tangible. The fight against stomach cancer is a global health priority, particularly as it increasingly affects younger populations. By focusing on effective prevention strategies, such as the treatment and eradication of H. pylori, we can pave the way for a healthier future. What further innovations and collaborations might emerge in the quest to combat this deadly disease? This article is based on verified sources and supported by editorial technologies. Did you like it? 4.3/5 (25)
Time of India
08-07-2025
- Health
- Time of India
Excessive burping could mean more than a full stomach—here's what your body's trying to tell you
Excessive burping could mean more than a full stomach—here's what your body's trying to tell you Burping or belching, a natural bodily function, releases the audible escape of the buildup of air from our stomach through our mouth. This excessive burping can be an alarming sign of underlying medical conditions or disorders. In order to understand what exactly these medical conditions are, this article explores the information around; what is burping, what causes it, excessive burping- symptoms of medical conditions, difference between occasional burping and frequent burping. Excessive burping is a sign of potential health issues and behavioural disorders. What is burping or belching? Remember getting scolded by your mother at the dinner table for making a sound after a hearty meal? That sound is called Burping. Belching or Burping is a natural process of releasing the air trapped in your stomach through your mouth. In layman's words, when we swallow any kind of food or drink, we end up swallowing air along with it, and this air stretches our stomach until its limit, then a muscle at the lower end of the stomach called the oesophagus relaxes, releasing the trapped air through the mouth. This entire process is called burping or belching, or eructation. by Taboola by Taboola Sponsored Links Sponsored Links Promoted Links Promoted Links You May Like One plan. Total peace of mind. ICICI Pru Life Insurance Plan Get Quote Undo What causes excessive burping? The very prominent question, 'What causes burping?'- is an answer that is associated with several reasons. These reasons are further categorised into two: 'normal burping' or 'symptom of underlying health condition'. The swallowing of air is the primary cause of excessive burping, which can be done during the following activities: Eat and drink too quickly Talk while eating Drinking Carbonated beverages Wearing ill-fitting dentures Chewing Gum Smoking Excessive burping: Symptom of potential health issues When the burping is frequent and accompanied by other symptoms like abdominal pain, nausea, bloating, weight loss, etc. It is a sign of potential health issues as below: Gastroesophageal Reflux Disease (GERD) When stomach acid flows back up the oesophagus, it leads to gastroesophageal reflux, also known as acid reflux. According to a study published in the National Library of Medicine , excessive belching is considered not just an isolated syndrome but also an associated symptom in patients with gastroesophageal reflux (GERD). Functional Dyspepsia/Chronic Indigestion Functional Dyspepsia or Indigestion is a pattern of symptoms that occur together. It occurs while you are eating and digesting. The isolated symptom of dyspepsia is frequent belching along with discomfort in the upper belly, nausea, and bloating. Helicobacter Pylori Infection Helicobacter Pylori is a bacteria that causes H. Pylori infection, also known as stomach infection. One of the most common symptoms of this infection is frequent belching or burping. Supragastric Belching According to a study published in the National Library of Medicine , Supragastric Belching is a clearly defined pattern found in patients of aerophagia (frequent belching). Meganblase Syndrome Meganblase syndrome is a functional gas bloat syndrome that includes swallowing of large amounts of air while eating or drinking. This air reaches the stomach and creates a large bubble that escapes through burping. This entire process is quite painful for a human body and its symptoms are somewhat similar to heart attack. How to avoid excessive burping It is to be noted that excessive belching can be avoided; however, if it is a symptom of a medical condition, then professional help is needed. The following are lifestyle tips to get rid of excessive burping: Avoid carbonated drinks such as soda, beer and similar others Avoid foods high in carbohydrates- Eat your food and drink slowly Quit smoking Wear fitted dentures Take a short walk or physical exercise after eating Also read | Control high blood pressure using this common kitchen ingredient, says Harvard doctor
The Sun
07-07-2025
- Health
- The Sun
Common food and waterborne bug to blame for millions of cases of ‘silent cancer' mistaken for heartburn
A COMMON bug lurking in food and water is driving millions of cases of cancer worldwide, experts warn. New research from the International Agency for Research on Cancer (IARC), part of the WHO, reveals that around 15.6 million people born between 2008 and 2017 will face stomach cancer in their lifetime. 1 Of these cases, some 11.9 million (76 per cent) will be due to infection with Helicobacter pylori (H. pylori). It's a common stomach bacteria spread through person-to-person contact and contaminated food or water. Asia bears the brunt of new cases, with countries like India and China hardest hit. But the Americas might see as many 2 million cases, Africa 1.7 million, and Europe 1.2 million. H. pylori is a bacteria that infects the lining of the stomach. Detecting the bug is simple, using blood, breath or stool tests, and treatment typically involves antibiotics. But most people never realise they're infected. This is because when symptoms do appear, they can easily be mistaken for run-of-the-mill indigestion, which can cause bloating, nausea, heartburn, or feeling full quickly after eating. Other symptoms include loss of appetite or losing weight without trying, stomach pain, a lump feeling at the top of the stomach and feeling very tired. Experts say this could be fuelling a surge in stomach cancer, often dubbed a 'silent killer' because symptoms are vague and easy to ignore. Netflix star Rob 'The Rabbit' Pitts dies at 45 following health battle after telling fans goodbye in heartbreaking clip Scientists are still working to understand exactly how the bug causes cancer. It's also been linked to non-Hodgkin lymphoma, a type of blood cancer. The authors of the study, published in Nature Medicine, are now calling for greater investment in the prevention of stomach cancer, particularly through population-wide "screen and treat" programmes for H. pylori. However, Cancer Research UK said stomach cancer rates in the UK have actually been falling - over the last decade, they have dropped 26 per cent and are projected to fall further by 2040. Dr Rachel Orritt, a health information manager at the charity, said: "H. pylori infection increases the risk of stomach cancer, but it's not a common infection in the UK. "It's also important to note that stomach cancer cases have been decreasing in the UK for decades, and they're expected to continue to fall. "Although this is an important issue worldwide, in the UK other preventable factors cause more cancer cases. "Ways to reduce your cancer risk include stopping smoking, keeping a healthy weight, cutting down on alcohol and eating a healthy, balanced diet." For the study, scientists examined the incidence of stomach cancer from 185 countries in 2022 and combined it with projections of future deaths. They looked at the potential impact of screen-and-treat strategies for H. pylori and found the number of stomach cancers could be cut by up to 75 per cent overall. Asia accounts for two thirds of projected future cases, with 10.6 million cases (68 per cent of the total), followed by the Americas (2m or 13 per cent), Africa (1.7 million or 11 per cent), Europe (1.2m or 8 per cent), and Oceania (0.07m or 0.4 per cent). Dr Jin Young Park, leader of the gastric cancer prevention team at IARC and co-author of the study, said: "It is essential that health authorities make gastric cancer prevention a priority and accelerate efforts to control it by planning pilot and feasibility projects, including H. pylori screen-and-treat programmes."
Medscape
20-05-2025
- Health
- Medscape
Teenaged Boy With Epigastric Pain
Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians, but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please email us at ccsuggestions@ with the subject line "Case Challenge Suggestion." We look forward to hearing from you. Background and Initial Presentation A 13-year-old boy presents to the emergency department (ED) with a history of epigastric pain, vomiting, malaise, polyuria, and a 12-lb weight loss during the past 3 months. His parents have brought him to the emergency department today because his pain and vomiting are worsening. They report no history of hematuria, hematemesis, fever, or chills. They also do not note any other associated symptoms, prior surgeries, or medical conditions. The patient was previously seen by his pediatrician and is undergoing a workup. Upper gastroendoscopy performed at a nearby hospital 2 weeks ago had revealed chronic gastritis with erosive changes in the antral region. Triple treatment for Helicobacter pylori , however, did not lead to any improvement. Abdominal ultrasonography also performed at that time showed mild nephrocalcinosis. Family history is negative for diabetes mellitus and porphyria. Physical Examination and Workup Upon physical examination, the child is thin and mildly ill-appearing. His temperature is 98.6°F (37°C); his pulse has a regular rhythm, with a rate of 80 beats/min; and his blood pressure is 120/70 mm Hg. The patient's respirations are regular and unlabored at 14 breaths/min. The child is in mild distress secondary to his epigastric discomfort. The examination of the head and neck is normal, except that the oropharynx appears slightly dry. He has no dysmorphic facial features. His lungs are clear to auscultation, and normal respiratory effort is noted. The S1 and S2 heart sounds are normal, and no murmurs are detected. The abdomen is soft but tender to deep palpation in the epigastric region. The patient's extremities show no edema, and brisk capillary refill is noted. His skin is clear except in the gluteal region, where a nodular eczematous lesion is present. Routine laboratory tests reveal a normal complete blood count and normal values for sodium, potassium, chloride, bicarbonate, and magnesium. The patient's blood urea nitrogen and serum creatinine values are elevated (22.4 mg/dL and 1.8 mg/dL, respectively). The calcium level is elevated at 14.4 mg/dL, which is confirmed with an ionized calcium level of 7.2 mg/dL. The phosphorus level is low, at 5 mg/dL. Hepatic aminotransferase values are slightly elevated (aspartate aminotransferase, 61 U/L; alanine aminotransferase, 201 U/L) and the bilirubin level is 0.7 mg/dL. Alkaline phosphatase level is somewhat elevated at 137 IU/L. A chest radiograph is obtained (Figure). Figure. Chest radiograph demonstrating combined hilar lymphadenopathy and reticulonodular interstitial infiltrates in the upper lung zone. (Note: This image is from a different patient with a similar condition.) The patient is hospitalized. During the hospital course, additional laboratory tests are performed. The thyroid hormone levels are in the normal range, but the parathyroid hormone level is low, at 10.91 pg/mL (normal range, 15-65 pg/mL). Vitamin D metabolites are not measured. The serum angiotensin-converting enzyme (ACE) level is normal, at 32.7 U/L (normal range, 12-42 U/L). The results of a purified protein derivative test are negative. Urinalysis performed on several occasions shows a specific gravity of 1.003 and a pH of 5, with normal urinary sediment. Urinary culture findings are negative. On several occasions, marked hypercalciuria is observed, with a calcium level of 14 mg/kg and a urinary calcium/creatinine ratio (mmol/mmol) that ranges from 2.5 to 3.5. No glycosuria or aminoaciduria is noted. Ultrasonography is performed, on which the parathyroid glands appear normal. Renal ultrasonography confirms mild nephrocalcinosis around the renal calices. A renal biopsy is performed. The specimen exhibits tubulointerstitial nephritis associated with tubular calcium deposits. Other findings include interstitial infiltration by mononuclear cells, interstitial fibrosis, tubular necrosis, and atrophy. Dystrophic calcifications are present in some of the tubules. Negative results are obtained for immunoglobulin (Ig) A, IgG, IgM, and C3 on immunofluorescence analysis. Immunohistochemical analysis reveals inflammatory cellular substrate CD68, macrophages, and lymphoid population. No glomerular abnormalities are evident. The clinical picture of this patient was dominated by nonspecific constitutional symptoms, such as malaise, vomiting, abdominal cramps, and weight loss. He had no history of maculopapular rashes, erythema nodosum, arthritis, chronic lymphocytopenia, hepatomegaly, splenomegaly, lymphadenopathy, or uveitis. He also did not have any coughing or exertional dyspnea. The child did have vomiting and polyuria, which were caused by hypercalcemia. The renal biopsy specimen indicated acute tubulointerstitial nephritis associated with tubular calcium deposits, without glomerular abnormalities. In addition, the chest radiograph demonstrated combined hilar lymphadenopathy and reticulonodular interstitial infiltrates in the upper lung zone. The chest radiography findings, when considered along with the hypercalcemia, rash, and renal biopsy results, are consistent with stage 2 radiographic sarcoidosis.[1] Symptoms of Fanconi syndrome in children are failure to thrive, growth retardation, and rickets, which does not describe this patient. Diagnosis is by demonstrating glucosuria, phosphaturia, and aminoaciduria.[2] Although a variety of glomerular lesions, including IgA nephropathy, are described as glomerular damage in sarcoidosis, they are not distinguishable from their primary form.[3] Moreover, this patient has a tubulointerstitial nephritis which is seen more often in sarcoidosis than IgA nephropathy (the latter is typically more a glomerulonephritis). Bartter syndrome, a rare inherited salt-losing renal tubular disorder, is associated with secondary hyperaldosteronism with hypokalemic and hypochloremic metabolic alkalosis and low to normal blood pressure,[4] which does not describe this patient. Discussion Hypercalcemia and/or hypercalciuria may occur in less than a third of cases of pediatric sarcoidosis.[1] Measuring baseline serum calcium levels is recommended to screen for abnormal calcium metabolism in patients with sarcoidosis, even in asymptomatic patients.[5] A rare cause of clinically manifested hypercalcemia is vitamin D intoxication, but it is associated with significant morbidity. It may be caused by endogenous synthesis of 1,25-dihydroxyvitamin D from subcutaneous fat necrosis, granulomatous disease, or by excessive exogenous vitamin D intake.[1] Hypercalcemia may also result from primary hyperparathyroidism or from increased levels of parathyroid hormone-related protein caused by certain malignancies.[6] Lastly, hypercalcemia may occur in patients with hypophosphatemia, vitamin A intoxication, or blue-diaper syndrome, or it may occur in association with use of certain medications, most notably hydrochlorothiazide and other thiazide diuretics.[6] An intact parathyroid hormone (PTH) level at the time of hypercalcemia is pivotal in narrowing the differential diagnosis. If the PTH level is high, the child must be thoroughly investigated for the cause of hyperparathyroidism and may require urgent surgical intervention. If the PTH level is low (as it was in this patient), additional calciotropic hormones may be assayed if appropriate testing is available. Identifying the abnormal calciotropic hormone might allow diagnosis of the specific cause, elucidation of the mechanism for the hypercalcemia, and optimal treatment.[7] Sarcoidosis is a multisystem disorder characterized by an increased cellular immune response to an unknown antigen and the formation of noncaseating granulomas in affected tissues. Although the lungs and lymph nodes are the predominant sites affected by sarcoidosis, other organs, such as the eyes, bone marrow, kidneys, liver, and spleen, may also be involved.[1,8] Cases of extrapulmonary sarcoidosis affecting the kidneys are rare; most such cases present with nephrocalcinosis or nephrolithiasis. Renal failure is an extremely uncommon manifestation.[1] As noted previously, an intact PTH level at the time of hypercalcemia is important in narrowing the differential diagnosis. If the PTH level is high, the child must be completely investigated for the cause of hyperparathyroidism and may need urgent surgery. If the PTH level is low (as it was in this patient), additional calciotropic hormones may be examined if appropriate testing is available. Identification of the abnormal calciotropic hormone might facilitate diagnosis of the cause, clarification of the mechanism for the hypercalcemia, and appropriate treatment.[7] Hypercalcemia in sarcoidosis is relatively uncommon.[1] It is usually caused by the autonomous production of 1,25-dihydroxyvitamin D (calcitriol) by macrophages within the granuloma. These macrophages can convert 25-hydroxyvitamin D, produced by the liver, into calcitriol by possessing the 1-alpha-hydroxylase enzyme. Calcitriol then travels to the intestinal cells and promotes luminal absorption of calcium and phosphate into the circulation. Hypercalcemia is accompanied by hypercalciuria and, eventually, nephrocalcinosis (as seen in this case). Hypercalcemia may also eventually cause renal failure both by causing dehydration and by inducing renal vasoconstriction, thereby reducing the glomerular filtration rate.[1,6] Excess PTH production can produce significant bone loss, which is not seen in this patient.[7] High levels of magnesium are not directly linked to sarcoidosis. The lungs and lymph nodes are the predominant sites that are affected by sarcoidosis,[9] and also the liver in children,[8] although other organs, including the eyes, bone marrow, kidneys, and spleen, may additionally be involved.[1,8,9] Pediatric sarcoidosis is a rare disease, with an estimated incidence of 0.6 to 1.02 per 100,000 children.[8] Two distinct forms of childhood sarcoidosis appear to exist. Older children usually present with a multisystem disease similar to the adult manifestation, with frequent lymphadenopathy and pulmonary involvement. They also show generalized signs and symptoms, such as fever and malaise. In contrast, early-onset childhood sarcoidosis is a unique form of the disease characterized by the triad of rash, uveitis, and arthritis, usually in patients who are younger than 4 years.[9] Pulmonary disease and abnormal findings on chest radiography are more common in children with sarcoidosis aged 8-15 years, compared with those younger than 4 years.[9] Bilateral hilar adenopathy is the most common finding on chest radiography in children; it occurs in almost all cases. It is typically symmetrical, although rarely it may occur unilaterally. Pulmonary parenchymal involvement is common and most often appears radiographically as an interstitial pattern; however, nodular, alveolar, and fibrotic patterns have also been noted. Of note, although chest radiography may be sufficient for the diagnosis, high-resolution chest CT may be helpful in evaluating lung changes[1,9] and is superior to conventional CT for detecting and demonstrating diagnostic findings in the lungs.[10] Other uncommon manifestations include pleural effusion, pneumothorax, pleural thickening, calcification, and cor pulmonale, and atelectasis.[1] The serum ACE level is increased in many patients with sarcoidosis. Sensitivity and specificity as a diagnostic test is limited. The serum ACE level may be normal in patients with active disease.[9] Many children with sarcoidosis have palpable peripheral lymph glands. The lymph nodes generally are firm, nontender, discrete, and easily movable. They neither ulcerate nor form draining sinuses. The glands involved most often are the cervical, axillary, epitrochlear, and inguinal glands. In the neck, the posterior triangle nodes are affected more frequently than the nodes in the anterior triangle. The enlarged peripheral lymph nodes are the most accessible tissue for biopsy. Hepatosplenomegaly often occurs in children with sarcoidosis at some point in their clinical course, but clinically significant hepatic dysfunction is rare. Mild elevation in biochemical liver function test values is common (as it was in this patient), but severe liver involvement is uncommon in children.[9] Ocular involvement is very common in children with sarcoidosis, and a complete ophthalmologic evaluation, including a slit-lamp examination, is essential (particularly in young children). Sarcoidosis may affect any part of the eye or orbit. Anterior uveitis (also called "iritis" or "iridocyclitis") is the most frequently noted lesion.[9] The patient should be examined for a decrease in visual acuity, eye pain, a red eye, or any other visual aberration that can indicate a posterior or anterior uveitis.[8] Sarcoid-associated uveitis can be acute or chronic and may vary from an isolated iridocyclitis to a bilateral panuveitis syndrome. If left untreated, the disease may cause synechiae, corneal opacities, glaucoma, and, eventually, blindness.[1,9] Renal involvement is not well characterized in published series of childhood sarcoidosis. Histopathologic studies have revealed epithelioid granuloma formation, interstitial infiltration by mononuclear cells, interstitial fibrosis, tubulitis, tubular atrophy, mesangial hyperplasia, glomerular fibrosis, and vascular involvement.[9] Corticosteroids remain the cornerstone of therapy for sarcoidosis, but immunosuppressive, cytotoxic, and immunomodulatory agents are viable therapeutic options for patients who do not respond to or experience adverse effects from corticosteroids. The published data most extensively documents treatment with methotrexate,[1,8] but favorable responses have been noted with leflunomide, azathioprine, and antimalarial and antimicrobial agents, as well as with tumor necrosis factor–alpha inhibitors. The dosage and the duration of corticosteroid therapy must often be individualized. Treatment is continued until the clinical manifestations of the disease resolve or show significant improvement.[9,11] For cutaneous sarcoidosis that cannot be controlled by local treatment, consideration of oral glucocorticoids is suggested.[11 More recently, repository corticotropin injection been suggested as an alternative in patients who are on high-dose prednisone.[9] The patient in this case received prednisone, 1.5 mg/kg per day for 1 month, with gradual tapering of the dose over the following 4-5 months. Hypercalcemia and renal failure reversed completely, as did the pulmonary changes seen on radiography. No recurrence was observed at 1-year follow-up. Renal nephrocalcinosis persisted, however, despite symptomatic and biochemical improvement. During corticosteroid therapy, measurement of the urinary beta-2-microglobulin concentration by sodium dodecyl sulfate polyacrylamide gel electrophoresis proved a valuable monitoring tool for assessing recovery of the tubular impairment. Chest radiography obtained after 3 weeks of corticosteroid therapy showed resolution of the findings seen in the original chest radiograph. This patient represents a rare case of sarcoidosis presenting with acute renal failure and hypercalcemia as the initial manifestations. Sarcoidosis should be considered in the differential diagnosis of hypercalcemia and renal failure,[1,9] occurring singly or in combination. Corticosteroids are useful for treatment.[1,8,9] As noted previously, hypercalcemia in sarcoidosis is uncommon[1] and usually results from autonomous production of 1,25-dihydroxyvitamin D (calcitriol) by macrophages within the granuloma. These macrophages can convert 25-hydroxyvitamin D, produced by the liver, into calcitriol by possessing the 1-alpha-hydroxylase enzyme. At that point, calcitriol travels to the intestinal cells and facilitates luminal absorption of calcium and phosphate into the circulation. Hypercalcemia is accompanied by hypercalciuria and, eventually, nephrocalcinosis.[1,6,9] A rare cause of clinically manifested hypercalcemia is vitamin D intoxication, which may be caused by excessive exogenous vitamin D intake.[1,6,9] Hypercalcemia may also result from primary hyperparathyroidism or from increased levels of parathyroid hormone-related protein caused by certain malignancies.[1,6,9] As noted previously, corticosteroids are the cornerstone of therapy for sarcoidosis,[1,9] but viable therapeutic options include immunosuppressive, cytotoxic, and immunomodulatory agents for patients who do not respond to or experience adverse effects from corticosteroids. Published data mainly documents treatment with the immunosuppressant methotrexate,[1,8] but favorable responses have been seen with leflunomide, mycophenolate mofetil, azathioprine, and antimalarial and antimicrobial agents, as well as with tumor necrosis factor-alpha inhibitors. Treatment options do not include fungicides, antiviral drugs, and antibiotics; granulomatous pulmonary infections caused by mycobacteria and fungi should have been ruled out.[1] For cutaneous sarcoidosis that is not controlled by local treatment, oral glucocorticoids could be considered.[11] For patients on high-dose prednisone, a suggested alternative is repository corticotropin injection.[9] The dosage and the duration of corticosteroid therapy must often be individualized. The treatment is continued until the clinical manifestations of the disease resolve or show significant improvement.[9,11]
