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Arredondo Montero J, Peñafiel-Freire DM, Carracedo Vega E, Antona G, de Oliveira Gomes AS, Bronte Anaut M. Pediatric Collagenous Gastritis: A Case Series With Clinical, Endoscopic and Histopathological Correlation. Clin Pediatr (Phila) 2024; 63:599-603. [PMID: 37424363 DOI: 10.1177/00099228231184351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Affiliation(s)
- Javier Arredondo Montero
- Department of Pediatric Surgery, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Navarra, Spain
| | | | - Elena Carracedo Vega
- Department of Pathology, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Giuseppa Antona
- Department of Pediatric Surgery, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | | | - Mónica Bronte Anaut
- Department of Pathology, Hospital Universitario de Araba, Vitoria-Gasteiz, Spain
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Isoldi S, Viola F, Cucchiara S, Dilillo A, Iorfida D, Testi AM, Fiorentino F, Mallardo S. Management of collagenous gastritis in children: Case series and literature review. Indian J Gastroenterol 2024; 43:567-577. [PMID: 37971571 DOI: 10.1007/s12664-023-01472-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/10/2023] [Indexed: 11/19/2023]
Abstract
Collagenous gastritis (CG) is a rare histopathological finding on gastric biopsies in children. It is associated with abdominal pain and iron deficiency anemia, usually not respondent to oral iron supplements. The aim of this study was to describe our experience in the management of pediatric patients with CG. Moreover, we propose to review the literature on this topic. We retrospectively reviewed all pediatric patients diagnosed with CG at our centre from January 2014 to January 2019. Three pediatric patients (2 F, mean age 12.3) were diagnosed with CG during the study period. Two presented with moderate and one with severe anemia. Symptoms were abdominal pain, asthenia and headache in two and asthenia and abdominal pain in one. All underwent upper and lower gastrointestinal endoscopy. All were firstly started with oral iron supplements with no benefit, principally due to poor compliance secondary to the worsening of the epigastric pain and proton pump inhibitor resistance. Therefore, they underwent ferric carboxymaltose (FCM) infusion with good clinical and laboratory response. Patients received a mean of two infusions/year, with stable hemoglobin levels and no adverse outcomes. Our review failed to identify a consistent response to specific treatments. Considering the apparent benign nature of the disease, symptomatic and supportive treatments are advisable. Iron deficiency anemia is largely present and therapy with oral iron supplements is not always successful. In our study, FCM infusion was effective in increasing the key blood indices in patients who poorly tolerated oral supplements.
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Affiliation(s)
- Sara Isoldi
- Pediatric Gastroenterology and Hepatology Unit, Santobono-Pausilipon Children's Hospital, Via Mario Fiore, 6, Naples, Italy.
- Maternal and Child Health Department, Sapienza - University of Rome, Polo Pontino, Latina, Italy.
- Santa Maria Goretti Hospital, Latina, Italy.
| | - Franca Viola
- Maternal and Child Health Department, Pediatric Gastroenterology and Liver Unit, Sapienza - University of Rome, Rome, Italy
| | - Salvatore Cucchiara
- Maternal and Child Health Department, Pediatric Gastroenterology and Liver Unit, Sapienza - University of Rome, Rome, Italy
| | - Anna Dilillo
- Maternal and Child Health Department, Sapienza - University of Rome, Polo Pontino, Latina, Italy
| | - Donatella Iorfida
- Maternal and Child Health Department, Sapienza - University of Rome, Polo Pontino, Latina, Italy
| | - Anna Maria Testi
- Hematology, Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
| | - Francesco Fiorentino
- Pathology Unit, Sapienza - University of Rome, Polo Pontino, Santa Maria Goretti Hospital, Latina, Italy
| | - Saverio Mallardo
- Maternal and Child Health Department, Sapienza - University of Rome, Polo Pontino, Latina, Italy
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Illan Montero J, Viala J, Rebeuh J, Berthet S, Blais R, Caldari D, Lasfargue M, Henaff GL, Mas E, Rustom-Pecciarini N, Berrebi D, Henno S, Dabadie A. Collagenous gastritis in children: A national cohort. Arch Pediatr 2023:S0929-693X(23)00079-9. [PMID: 37236887 DOI: 10.1016/j.arcped.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/05/2023] [Accepted: 03/25/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Collagen gastritis is a rare disease that manifests in children mainly as isolated gastric involvement associated with martial deficiency anemia. There are no recommendations for the management and follow-up of these patients. We aimed to describe the clinical data, endoscopic findings, and treatments deployed in France's children with collagenous gastritis. METHODS All French pediatric gastroenterology centers and pediatric centers for rare digestive diseases (Centres de Maladies Rares Digestives) were contacted to collect cases of collagenous gastritis, defined on gastric biopsies and diagnosed before 18 years of age. RESULTS A total of 12 cases diagnosed (4 males and 8 females) between 1995 and 2022 could be analyzed. The median age at diagnosis was 12.5 years (7-15.2). The most frequent clinical presentation was abdominal pain (6/11) and/or nonspecific symptomatology attributed to anemia (8/10). Anemia was present in all children (11/11; Hb 2.8-9.1 g/dL). Nodular gastritis was present in 10 patients (antrum: 2; fundus: 4; in antrum and fundus: 4). All patients had a basement membrane thickening (from 19 to 100 μm). The treatments received were PPI (11), oral or intravenous martial supplementation (12), budesonide (1), and prednisone (1). Martial supplementation improved anemia in all cases. At discontinuation, nine of 10 patients had a recurrence of anemia. CONCLUSION Collagenous gastritis is an exceptional condition, clinically manifested in children as abdominal pain and iron deficiency anemia probably of hemorrhagic origin. Patients require long-term follow-up and monitoring of their disease to describe the risk of progression better.
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Affiliation(s)
- Jonathan Illan Montero
- Department of Pediatrics, University Hospital of Vaud (CHUV), 1011 Lausanne, Switzerland.
| | - J Viala
- Pediatric Gastroenterology and Nutrition Department, Robert Debré University Hospital, AP-HP, 75019 Paris, France; Paris Cité University, Paris, France
| | - J Rebeuh
- Department of Pediatrics, Strasbourg University Hospital, 67000 Strasbourg, France
| | - S Berthet
- Pediatric Gastroenterology, Saint George Polyclinic, 06105 Nice, France
| | - R Blais
- Department of Pediatrics, Le Mans Hospital, 72037 Le Mans, France
| | - D Caldari
- Department of Pediatric, Mother and Child Hospital, Nantes University Hospital, 44000 Nantes, France
| | - M Lasfargue
- Department of Pediatric, Mother and Child Hospital, Grenoble University Hospital, 38700 Grenoble, France
| | - G Le Henaff
- Pediatric Gastroenterology, Santé Atlantique-ELSAN Polyclinic, 44800 Saint-Herblain, France
| | - E Mas
- Unité de gastroentérologie, hépatologie, nutrition et diabétologie, hôpital des Enfants, 330, avenue de Grande-Bretagne, TSA 70034, 31300 Toulouse cedex 9, France; Inserm U1043, 31300 Toulouse, France; CNRS, U5282, 31300 Toulouse, France
| | - N Rustom-Pecciarini
- Department of Pediatrics, Annecy Gennevois University Hospital, 74370 Epagny Metz-Tessy, France
| | - D Berrebi
- Paris Cité University, Paris, France; Department of Pediatric Pathology, Robert Debré University and Necker Hospital, AP-HP, 75019 and 75015 Paris, France
| | - S Henno
- Department of Pathology, University Hospital Pontchaillou, 35000 Rennes, France
| | - A Dabadie
- Department of Pediatrics, Rennes South University Hospital, 35200 Rennes, France.
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Zheng QH, Hu J, Yi XY, Xiao XH, Zhou LN, Li B, Bo XT. Collagenous gastritis in a young Chinese woman: A case report. World J Gastroenterol 2022; 28:5993-6001. [PMID: 36405104 PMCID: PMC9669833 DOI: 10.3748/wjg.v28.i41.5993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/21/2022] [Accepted: 10/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Collagenous gastritis (CG) is a rare condition whose pathogenesis may be related to immune abnormalities. We report a case of CG from China.
CASE SUMMARY A 24-year-old woman presented with recurrent abdominal distension and discomfort for 3 mo. Upper gastrointestinal endoscopy found diffuse nodular elevation-depression changes in the mucosa of the entire gastric corpus. Endoscopic ultrasound showed predominant involvement of the lamina propria and submucosa, and computed tomography imaging showed mild enhancement of the gastric wall. Pathological histology revealed that the thickness of the subepithelial collagen band was about 40 μm, and the Masson trichrome staining result was positive and the Congo red staining result was negative. This case is consistent with the child-adolescent type of CG.
CONCLUSION Serum pepsinogen I, pepsinogen II, pepsinogen I/II ratio, and gastrin-17 may be potential non-invasive monitoring markers. Currently, treatments for CG vary, and the likely prognosis is unknown. Individual cases of gastric cancer in patients with CG have been reported.
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Affiliation(s)
- Qing-Hua Zheng
- Department of Gastroenterology, Affiliated Hospital of Guilin Medical University, Guilin 541001, Guangxi Province, China
| | - Jie Hu
- Department of Gastroenterology, Affiliated Hospital of Guilin Medical University, Guilin 541001, Guangxi Province, China
| | - Xiao-Yuan Yi
- Department of Gastroenterology, Affiliated Hospital of Guilin Medical University, Guilin 541001, Guangxi Province, China
| | - Xu-Hua Xiao
- Department of Gastroenterology, Affiliated Hospital of Guilin Medical University, Guilin 541001, Guangxi Province, China
| | - Li-Na Zhou
- Department of Gastroenterology, Affiliated Hospital of Guilin Medical University, Guilin 541001, Guangxi Province, China
| | - Bin Li
- Department of Gastroenterology, Affiliated Hospital of Guilin Medical University, Guilin 541001, Guangxi Province, China
| | - Xiao-Tong Bo
- Department of Gastroenterology, Affiliated Hospital of Guilin Medical University, Guilin 541001, Guangxi Province, China
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Kang B, Um SH, Yun J, Kim HK, Choe BH, Lee YM. Collagenous gastroduodenocolitis in a Korean adolescent: first pediatric case report in Asia. Transl Pediatr 2021; 10:3096-3103. [PMID: 34976776 PMCID: PMC8649595 DOI: 10.21037/tp-21-342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/29/2021] [Indexed: 12/11/2022] Open
Abstract
Collagenous gastritis (CG) is a rare disease diagnosed histologically by the subepithelial deposition of collagen bands thicker than 10 µm and the infiltration of inflammatory mononuclear cells in the lamina propria. The definite pathophysiology is yet to be elucidated. However, recent studies have suggested that the collagen deposition may be the result of a reparative process in response to an earlier inflammatory, autoimmune, infectious, or toxic insult. CG is divided into the pediatric- and adult-type. While the pediatric-type is limited to the stomach, the adult-type involves not only the stomach but also the intestine and/or colon. We report a rare case of adult-type CG in a 15-year-old boy who initially presented with abdominal pain and iron-deficiency anemia. Esophagogastroduodenoscopy (EGD) revealed findings suspicious for Helicobacter pylori (H. pylori) gastritis. Although histology did not reveal the organism, campylobacter-like organism (CLO) test was positive. Based on the diagnosis of suspicious H. pylori gastritis, eradication was conducted using the triple drug regimen. However, symptoms of intermittent abdominal pain persisted and diarrhea newly developed one year later. Histologic results from biopsies from the stomach, duodenum, and colon revealed findings compatible with CG, collagenous duodenitis (CD), and collagenous colitis (CC). This is the first pediatric case of collagenous gastroduodenocolitis (CGDC) reported in Asia. It is no longer assumed that adult-type and pediatric-type CG should be classified as an independent disease, but should be considered as similar diseases on a continuous spectrum. Therefore, children and adolescents diagnosed with CG should also consider undergoing a colonoscopy for the evaluation of possible coexisting CC when concurrent lower gastrointestinal symptoms are present. Moreover, considering the possibility of negative findings on the first endoscopy, repeat endoscopy should be considered when symptoms persist.
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Affiliation(s)
- Ben Kang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Soo Hyun Um
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Jaehun Yun
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Hee Kyung Kim
- Department of Pathology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Byung-Ho Choe
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yoo Min Lee
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
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Beinvogl BC, Goldsmith JD, Verhave M. Pediatric Collagenous Gastritis: Clinical and Histologic Outcomes in a Large Pediatric Cohort. J Pediatr Gastroenterol Nutr 2021; 73:513-519. [PMID: 34173792 DOI: 10.1097/mpg.0000000000003212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of the study was to present the clinical characteristics, treatment, and outcomes of pediatric collagenous gastritis (CG). METHOD This is a retrospective cohort study. Patients were identified via query of the institutional pathology database. Clinical data was obtained by review of medical records. RESULTS Forty patients (57.5% female) were identified, mean age 11.3 ± 3.7 years (2-16years). Isolated CG was present in 66.7%, coexisting collagenous duodenitis (CD) in 17.5%, collagenous colitis (CC) in 7.5%, and collagenous ileitis in 2.5%. Atopic comorbidities were found in 25%, autoimmune comorbidities in 12.5%. PRESENTING SYMPTOMS Abdominal pain (77.5%), vomiting (65%), anemia (57.5%), nausea (55.5%), diarrhea (32.5%), anorexia (25.0%), weight loss (25%), gastrointestinal bleed (22.5%), poor growth (20%), poor weight gain (12.5%). ENDOSCOPIC FINDINGS All had abnormal endoscopic findings on esophago-gastro-duodenoscopy (EGD), most commonly gastric nodularity (77.5%), visible blood (20%), erosions/superficial ulcerations (10%), ulcers (7.5%). Histologically, all patients had increased subepithelial collagen deposition. TREATMENT A variety of medications aimed towards inflammation and symptomatic treatment were used. Patients with anemia received iron supplementation and responded. Otherwise, there was no significant association of clinical or histologic improvement with specific treatments. CLINICAL AND HISTOLOGIC OUTCOMES 87.5% reported improvement or resolution of symptoms at the last follow-up (34.8 ± 27.0 months). Persistent sub-epithelial collagen was noted in 73.1% on the last EGD. CONCLUSIONS Despite persistent findings of increased sub-epithelial collagen deposition during the follow-up period, most patients with CG show remission or resolution of clinical symptoms. Anemia responds to iron supplementation in all patients.
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Affiliation(s)
- Beate C Beinvogl
- Division of Pediatric Gastroenterology, Hepatology and Nutrition
| | | | - Menno Verhave
- Division of Pediatric Gastroenterology, Hepatology and Nutrition
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Collagenous Gastritis in Children: Incidence, Disease Course, and Associations With Autoimmunity and Inflammatory Markers. Clin Transl Gastroenterol 2021; 11:e00219. [PMID: 32955189 PMCID: PMC7431242 DOI: 10.14309/ctg.0000000000000219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Collagenous gastritis (CG), a rare disorder of unknown etiology, has been postulated to have immune-mediated mechanisms. We investigated (i) the incidence and prevalence of CG in a pediatric population; (ii) the clinical, endoscopic, and histologic characteristics of childhood-onset CG; and (iii) the evidence for autoimmunity and/or inflammatory activity in these patients.
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Collagenous Gastritis in Primary Selective IgM Deficiency: Transition to EBV+ Gastric Adenocarcinoma. Case Reports Immunol 2021; 2021:5574944. [PMID: 34123443 PMCID: PMC8172285 DOI: 10.1155/2021/5574944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/14/2021] [Indexed: 12/18/2022] Open
Abstract
Selective IgM deficiency (SIgMD) and isolated collagenous gastritis are two independent rare disorders. Our purpose is to report the 1st case of SIgMD and isolated collagenous gastritis and collagenous gastritis that has transitioned to EBV + gastric adenocarcinoma. Gastric biopsy tissue was analyzed by EBV-related encoded RNA in situ hybridization assay. Subsets of CD4, CD8, T follicular helper cells (TFH), and members of the “regulatory lymphocytes club” were measured with multiple panels of monoclonal antibodies and isotype controls by multicolor flow cytometry. The patient was diagnosed with SIgMD (extremely low serum IgM 9 mg/dl and normal IgG and IgA and exclusion of secondary causes of low IgM). Soon after SIgMD diagnosis, the patient developed collagenous gastritis and, 8 years later, developed gastric adenocarcinoma that was positive for EBV. An extensive immunological analysis revealed reduced naïve CD4 and CD8 effector memory T cells and increased naïve and central memory CD8 T cells. Among the circulating follicular helper T cells (cTFH), TFH1 and TFH2 were increased whereas TFH17 was decreased. CD4 Treg cells and TFR cells were increased, whereas Breg and CD8 Treg were comparable to control. In conclusion, SIgMD may be associated with isolated collagenous gastritis, and collagenous gastritis may transition to EBV + gastric adenocarcinoma. A role of regulatory lymphocytes in gastric cancer is discussed.
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Tesson JR, Grecourt L, Fumery M, Banse R, Kime A, Chatelain D. Une gastrite inhabituelle. Ann Pathol 2020; 40:414-417. [DOI: 10.1016/j.annpat.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 01/29/2020] [Accepted: 04/05/2020] [Indexed: 11/24/2022]
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10
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The differential diagnosis of Helicobacter pylori negative gastritis. Virchows Arch 2018; 473:533-550. [DOI: 10.1007/s00428-018-2454-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 06/12/2018] [Accepted: 09/05/2018] [Indexed: 02/07/2023]
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Zamani F, Boghratian A, Zare Mehrjardi A, Naserifar F, Vafaeimanesh J. Collagenous Gastritis, a Rare Cause of Dyspepsia Resistant to Treatment; A Case Report. Middle East J Dig Dis 2018; 10:263-266. [PMID: 31049176 PMCID: PMC6488506 DOI: 10.15171/mejdd.2018.121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 09/07/2018] [Indexed: 02/06/2023] Open
Abstract
Collagenous gastritis is hardly ever found in children and adults. Based on the extent of collagenous changes in the bowel, various symptoms may develop including iron deficiency, anemia, and abdominal pain in most of the patients. We present a 30-year-old man with persistent abdominal pain and anemia due to collagenous gastritis.
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Affiliation(s)
- Farhad Zamani
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Boghratian
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Zare Mehrjardi
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Naserifar
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jamshid Vafaeimanesh
- Associate Professor, Gastroenterology and Hepatology Disease Research Center, Qom University of Medical Sciences, Qom, Iran
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Abstract
INTRODUCTION Collagenous gastritis is a rare disease characterized by the subepithelial deposition of collagen bands. Two phenotypes of the disease have been described: a pediatric-onset and an adult-onset type. The adult-onset form is associated with collagenous colitis and autoimmune disorders. No effective treatment has been identified to date. OBJECTIVE We aim to describe the clinical features and outcomes of patients in our cohort and provide a summary of published pediatric cases with collagenous gastritis and colitis reported to date to gather information that will contribute to improved knowledge of this rare condition. METHODS A retrospective chart review of all patients with collagenous gastritis and/or colitis who were treated at the Royal Children's Hospital, Melbourne, was performed. A literature review was also conducted. RESULTS A total of 12 cases of collagenous gastritis were reviewed. Three of 12 (25%) patients had associated collagenous colitis. The most common clinical presentation was iron deficiency anemia. Nine (75%) patients were followed up, and repeat endoscopies were performed in 8 (67%). Iron deficiency anemia resolved in all patients on oral iron supplementation. Histologic improvement was only identified in one patient with the adult phenotype who had been treated with oral corticosteroids and azathioprine. CONCLUSIONS Collagenous gastritis is a rare condition in children. A small proportion of children develop features of the "'adult" phenotype at a very young age. Patients with collagenous gastritis require long-term follow-up and monitoring of their disease. Further randomized clinical trials are needed to establish an effective therapeutic strategy.
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Lim HW, Wong BY, Elkowitz D, Sultan K. An elderly patient's complete response to steroid therapy for collagenous gastritis. Ther Adv Chronic Dis 2018; 9:143-146. [PMID: 30065811 DOI: 10.1177/2040622318759628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/16/2018] [Indexed: 12/30/2022] Open
Abstract
An 85-year-old woman presented with 9.1 kg (20 lb) weight loss over 5 months and an acute onset crampy abdominal pain. Examination revealed a diffusely tender abdomen, with gastric wall thickening noted on CT scan. Upper endoscopy showed diffuse severe erythema and friability. Histologic examination with hematoxylin and eosin staining revealed collagenous gastritis characterized by active chronic inflammation with sub-epithelial collagen deposition and erosion. The patient was started on steroid therapy with rapid clinical improvement and tapered off over 2.5 months. At 6 months, the patient reported an improved appetite with resolution of her abdominal pain. Repeat endoscopy revealed a grossly normal stomach and normal mucosal biopsies. She remains without complaints 1 year later. Collagenous gastritis, rare in the elderly, is a histologic diagnosis characterized by the deposition of a sub-epithelial collagen band thicker than 10 µm with an inflammatory infiltrate. In all ages the mucosa typically appears nodular and erythematous, caused by an uneven inflammation in the surrounding depressed mucosa with atrophic changes. Specific therapy has not been well-established, and the prognosis and potential for endoscopic or histological resolution remains unclear. While anecdotal, the success of steroids may offer a reasonable starting point for treatment of similar cases.
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Affiliation(s)
- Huei-Wen Lim
- Northwell Health, 300 Community Drive, Manhasset, NY 11030, USA
| | | | | | - Keith Sultan
- Hofstra Northwell School of Medicine, Manhasset, NY, USA
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14
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Collagenous Gastritis and Helicobacter pylori Infection: A Mere Coincidence? ACG Case Rep J 2017; 4:e69. [PMID: 29367938 PMCID: PMC5569944 DOI: 10.14309/crj.2017.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/15/2017] [Indexed: 12/17/2022] Open
Abstract
A 21-year-old woman presented to our clinic after 7 years of abdominal pain,
diarrhea, and iron-deficiency anemia. Initial upper endoscopy revealed severe
inflammation and nodularity of the gastric body and active Helicobacter
pylori infection. After eradication therapy, esophagogastroduodenoscopy
showed gastric atrophy with nodularity resolution. Histopathology revealed scattered
plasma cells, eosinophils, and collagen deposition suggestive of collagenous
gastritis. H. pylori can induce proinflammatory cytokines, resulting
in fibroblast upregulation. Collagenous gastritis may be caused by an inflammatory
response associated with type I, II, and III collagen. Although further research is
warranted, we hypothesize that chronic inflammation from H. pylori
may lead to collagenous gastritis.
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15
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A Comparative Clinicopathologic Study of Collagenous Gastritis in Children and Adults. Am J Surg Pathol 2015; 39:802-12. [DOI: 10.1097/pas.0000000000000441] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Arnason T, Brown IS, Goldsmith JD, Anderson W, O'Brien BH, Wilson C, Winter H, Lauwers GY. Collagenous gastritis: a morphologic and immunohistochemical study of 40 patients. Mod Pathol 2015; 28:533-44. [PMID: 25234289 DOI: 10.1038/modpathol.2014.119] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 07/14/2014] [Accepted: 07/22/2014] [Indexed: 12/13/2022]
Abstract
Collagenous gastritis is a rare condition defined histologically by a superficial subepithelial collagen layer. This study further characterizes the morphologic spectrum of collagenous gastritis by evaluating a multi-institutional series of 40 patients (26 female and 14 male). The median age at onset was 16 years (range 3-89 years), including 24 patients (60%) under age 18. Twelve patients (30%) had associated celiac disease, collagenous sprue, or collagenous colitis. Hematoxylin and eosin slides were reviewed in biopsies from all patients and tenascin, gastrin, eotaxin, and IgG4/IgG immunohistochemical stains were applied to a subset. The distribution of subepithelial collagen favored the body/fundus in pediatric patients and the antrum in adults. There were increased surface intraepithelial lymphocytes (>25 lymphocytes/100 epithelial cells) in five patients. Three of these patients had associated celiac and/or collagenous sprue/colitis, while the remaining two had increased duodenal lymphocytosis without specific etiology. An eosinophil-rich pattern (>30 eosinophils/high power field) was seen in 21/40 (52%) patients. Seven patients' biopsies demonstrated atrophy of the gastric corpus mucosa. Tenascin immunohistochemistry highlighted the subepithelial collagen in all 21 specimens evaluated and was a more sensitive method of collagen detection in biopsies from two patients with subtle subepithelial collagen. No increased eotaxin expression was identified in 16 specimens evaluated. One of the twenty-three biopsies tested had increased IgG4-positive cells (100/high power field) with an IgG4/IgG ratio of 55%. In summary, collagenous gastritis presents three distinct histologic patterns including a lymphocytic gastritis-like pattern, an eosinophil-rich pattern, and an atrophic pattern. Eotaxin and IgG4 were not elevated enough to implicate these pathways in the pathogenesis. Tenascin immunohistochemistry can be used as a sensitive method of collagen detection.
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Affiliation(s)
- Thomas Arnason
- 1] Gastrointestinal Pathology Service, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA [2] Division of Anatomical Pathology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Ian S Brown
- 1] Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia [2] Envoi Pathology, Brisbane, QLD, Australia
| | - Jeffrey D Goldsmith
- Department of Pathology, Children's Hospital Boston, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Claire Wilson
- Providence Alaska Medical Center, Anchorage, AK, USA
| | - Harland Winter
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Gregory Y Lauwers
- Gastrointestinal Pathology Service, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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17
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Soeda A, Mamiya T, Hiroshima Y, Sugiyama H, Shidara S, Dai Y, Nakahara A, Ikezawa K. Collagenous gastroduodenitis coexisting repeated Dieulafoy ulcer: A case report and review of collagenous gastritis and gastroduodenitis without colonic involvement. Clin J Gastroenterol 2014; 7:402-9. [PMID: 26184019 DOI: 10.1007/s12328-014-0526-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
Abstract
Collagenous gastritis (CG) is a rare disorder characterized by the thick collagenous subepithelial bands associated with mucosal inflammation. There have been approximately fifty reports in the literature since it was first described in 1989. According to previous reports, CG is heterogeneous and classified into two groups-(1) cases limited to the gastric mucosa in children or young adults, and (2) CG associated with collagenous colitis in elderly adults presenting with chronic watery diarrhea. In Japan, only nine previous cases were reported, and all of them were young adults. We report a case of CG with collagenous duodenitis in a 22-year-old female. She had repeated upper gastrointestinal bleeding from a Dieulafoy lesion of the fornix, but had no symptoms of malabsorption or diarrhea. Endoscopic findings revealed striking nodularity with a smooth islet-shaped normal area in the antrum and the body. The pathological findings of nodular mucosa showed the deposition of collagen bands just under the mucoepithelial lesion. In addition, she had collagenous duodenitis in part of the bulbs, and a colonoscopy showed no abnormalities. We provide a literature review of CG and collagenous gastroduodenitis without colonic involvement.
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Affiliation(s)
- Atsuko Soeda
- Department of Gastroenterology, Tsukuba Memorial Hospital, 1187-299 Kaname, Tsukuba, Ibaraki, Japan,
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18
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Mandaliya R, DiMarino AJ, Abraham S, Burkart A, Cohen S. Collagenous Gastritis a Rare Disorder in Search of a Disease. Gastroenterology Res 2013; 6:139-144. [PMID: 27785244 PMCID: PMC5074812 DOI: 10.4021/gr564w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/03/2022] Open
Abstract
A 19-year-old young male presented with abdominal pain and constipation. Subsequent EGD showed nodular gastric mucosa with simple gastric aspirate demonstrating acidic pH of 2.0. The gastric biopsy showed thick subepithelial band of about 15 microns that was confirmed to be collagen on Masson's trichrome stain along with inflammatory infiltrate. Colonoscopy and capsule endoscopy findings were unremarkable as well as the biopsy of the colon. Collagenous gastritis is a rare histopathological entity characterized by the presence of thick subepithelial collagen band of thickness greater than 10 microns along with intraepithelial lymphocytes and lamina propria lymphoplasmacytic and eosinophilic infitrates. Clinical presentation varies and depends more on the age of the patient with anemia or epigastric pain with nodular gastric mucosa being more common in children while diarrhea being more common in adults due to its increased association with collagenous colitis. The purpose of this case report is; (A) To define the endoscopic and histopathological features and progression of collagenous gastritis in this patient; (B) To compare these findings to those of collagenous sprue and collagenous colitis.
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Affiliation(s)
- Rohan Mandaliya
- Department of Internal Medicine, Abington Memorial Hospital, USA
| | - Anthony J DiMarino
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, USA
| | - Sheeja Abraham
- Pediatric Gastroenterology, Thomas Jefferson University Hospital, USA
| | - Ashlie Burkart
- Department of Pathology, Thomas Jefferson University Hospital, USA
| | - Sidney Cohen
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospital
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19
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Hijaz NM, Septer SS, Degaetano J, Attard TM. Clinical outcome of pediatric collagenous gastritis: Case series and review of literature. World J Gastroenterol 2013; 19:1478-1484. [PMID: 23538318 PMCID: PMC3602509 DOI: 10.3748/wjg.v19.i9.1478] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 12/11/2012] [Accepted: 12/25/2012] [Indexed: 02/06/2023] Open
Abstract
Collagenous gastritis (CG) is characterized by patchy subepithelial collagen bands. Effective treatment and the clinical and histological outcome of CG in children are poorly defined. The aim of this study is to summarize the published literature on the clinical outcome and response to therapy of pediatric CG including two new cases. We performed a search in Pubmed, OVID for related terms; articles including management and clinical and/or endo-histologic follow up information were included and abstracted. Reported findings were pooled in a dedicated database including the corresponding data extracted from chart review in our patients with CG. Twenty-four patients were included (17 females) with a mean age of 11.7 years. The clinical presentation included iron deficiency anemia and dyspepsia. The reported duration of follow up (in 18 patients) ranged between 0.2-14 years. Despite most subjects presenting with anemia including one requiring blood transfusion, oral iron therapy was only documented in 12 patients. Other treatment modalities were antisecretory measures in 13 patients; proton pump inhibitors (12), or histamine-2 blockers (3), sucralfate (5), prednisolone (6), oral budesonide in 3 patients where one received it in fish oil and triple therapy (3). Three (13%) patients showed no clinical improvement despite therapy; conversely 19 out of 22 were reported with improved symptoms including 8 with complete symptom resolution. Spontaneous clinical resolution without antisecretory, anti-inflammatory or gastroprotective agents was noted in 5 patients (4 received only supplemental iron). Follow up endo-histopathologic data (17 patients) included persistent collagen band and stable Mononuclear cell infiltrate in 12 patients with histopathologic improvement in 5 patients. Neither collagen band thickness nor mononuclear cell infiltrate correlated with clinical course. Intestinal metaplasia and endocrine cell hyperplasia were reported (1) raising the concern of long term malignant transformation. In summary, CG in children is a chronic disease, typically with a variable clinical response and an indolent course that is distinct from the adult phenotype. Long term therapy usually inclused iron supplementation but cannot be standardized, given the chronicity of the disease, variability of response and potential for adverse events.
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20
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Macaigne G, Boivin JF, Harnois F, Chayette C, Dikov D, Cheaib S, Auriault ML. [Collagenous gastritis and ileo-colitis occurred in autoimmune context: report of a case and review of the literature]. ACTA ACUST UNITED AC 2010; 34:e1-6. [PMID: 20637552 DOI: 10.1016/j.gcb.2009.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Revised: 05/30/2009] [Accepted: 06/25/2009] [Indexed: 11/30/2022]
Abstract
Collagenous colitis belongs to the group of microscopic colitis. The aetiology and pathogenesis are unknown but different pathogenic hypothesis, autoimmune, infectious, alimentary and medicinal being are advanced, the last one being the most frequent aetiology. The collagenous gastritis is a rare entity and its association with collagenous colitis was exceptionally reported, only six cases being published. We report the seventh case of collagenous gastritis, ileitis and colitis in a 75-year-old woman with chronic diarrhea and important weight loss. This thickened subepithelial collagen band was appeared in an autoimmune injury context with antecedent of Hashimoto's thyroiditis and probably chronic atrophic Biermer's gastritis. The clinical and histological evolution was favourable with budesonide.
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Affiliation(s)
- Gilles Macaigne
- Service d'hépato-gastroentérologie, hôpital de Lagny-Marne-la-Vallée, 34 avenue du Général-Leclerc, 77405 Lagny-sur-Marne cedex, France.
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21
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Lauwers GY, Fujita H, Nagata K, Shimizu M. Pathology of non-Helicobacter pylori gastritis: extending the histopathologic horizons. J Gastroenterol 2010; 45:131-45. [PMID: 19967418 DOI: 10.1007/s00535-009-0146-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 09/29/2009] [Indexed: 02/04/2023]
Abstract
The development of modern endoscopic techniques, easier and greater access to healthcare, and interest in Helicobacter pylori infection and its implications have all led to a significant increase in upper endoscopies. In turn, gastroenterologists and pathologists have been recognizing an ever-increasing number of patterns of mucosal injury. Consequently, there is now an interest in a wider aspect of non-neoplastic gastric pathology, namely, non-HP (H. pylori) gastritis. In this review, we present major clinico-pathological entities, based on either the salient morphological features or the underlying etiologies.
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Affiliation(s)
- Gregory Y Lauwers
- Gastrointestinal Pathology Service, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street WRN 2, Boston, MA 02114-2696, USA.
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22
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Abstract
Collagenous gastritis is a rare disorder first described in 1989. After encountering two cases, we decided to review the literature and evaluate the collagen band. A systematic review of PubMed and EMBASE databases was performed. Twenty-eight cases have been previously described and two patterns of presentations are identifiable: children or young adults (median age 12 years, range 2-22 years) presenting with symptoms attributable to the gastritis (anaemia and pain); and older adults (median age 52 years, range 35-77 years) presenting with loose stools, often associated with collagenous colitis or coeliac disease. Our two cases (one child and one adult) matched this pattern. Immunostaining of the collagen band for collagens II, III, IV and VI, and tenascin showed that the band in our cases was predominantly tenascin. In conclusion, collagenous gastritis is a rare entity whose presentation depends on the age of the patient. An autoimmune aetiology seems possible given its associations. Treatment is empirical. The 30 cases now reported show that the disorder can relapse or persist for years.
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23
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Collagenous gastritis, a new spectrum of disease in pediatric patients: two case reports. CASES JOURNAL 2009; 2:7511. [PMID: 19829984 PMCID: PMC2740095 DOI: 10.4076/1757-1626-2-7511] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 04/20/2009] [Indexed: 11/12/2022]
Abstract
Collagenous gastritis is a rare gastrointestinal disorder characterized in pediatrics by abdominal pain and anemia. The literature divides collagenous gastritis into distinct pediatric-onset and adult-onset phenotypes. As opposed to pediatric form, the adult form is associated with collagenous colitis and presents clinically with voluminous non-bloody diarrhea. There are over 25 case reports of collagenous gastritis of which 10 are pediatric cases. We present two cases of pediatric onset collagenous gastritis: one with a classic pediatric presentation, the other with findings typical of adult-onset disease. This is the first report of the adult-onset phenotype collagenous gastritis in a pediatric patient.
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24
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Collagenous gastritis: histopathologic features and association with other gastrointestinal diseases. Am J Surg Pathol 2009; 33:788-98. [PMID: 19295410 DOI: 10.1097/pas.0b013e318196a67f] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Collagenous gastritis (CG) characterized by the deposition of a subepithelial collagen band and accompanying inflammatory infiltrate is a rare disorder. The natural history and pathogenesis of CG remain unclear. We describe the histologic features (23 gastric, 18 duodenal, and 4 colonic biopsies) and clinical findings of an additional 12 cases. Histologic features including active or chronic inflammation, surface epithelial injury, intraepithelial lymphocytosis, intestinal metaplasia, and Helicobacter pylori, and measurement of thickness of subepithelial collagenous band were evaluated in gastric biopsies. The clinical features, endoscopic findings, and follow-up were obtained and correlated with histologic features. There was an even number of males (n=6) and females (n=6). Four patients were children/young adults, 3 of whom (75%) presented with anemia and gastric nodularity. Eight patients were adults, 6 of whom (75%) had an associated autoimmune disease (1 with Hashimoto thyroiditis and polymyositis) or other intestinal disease (3 with celiac sprue, 1 with collagenous colitis, 1 with collagenous sprue), in contrast to none in the 4 children/young adults, P=0.06. The range of subepithelial collagen thickness was 15 to 120 microm in CG. The collagenous layer showed surface epithelial injury and entrapped inflammatory cells. On presentation, the thickened collagen distribution in the antrum and body was variably patchy and diffuse. Four (33%) patients showed lymphocytic gastritis (3 within the same biopsy); one of these patients also had celiac sprue and another had collagenous sprue. Three (25%) patients had celiac sprue (2 had duodenal biopsy proven and 1 had a clinical diagnosis of celiac sprue). An additional patient had duodenal biopsies showing collagenous sprue. Four patients had follow-up biopsies during a 3 to 119-month period after the diagnosis of CG. CG persisted on the follow-up gastric biopsies in 3 (75%) of the 4 patients, and the other patient had lymphocytic gastritis, a finding not seen in previous biopsies. CG is a rare disorder with a distinct presentation and association in pediatric and adult patients. An absence of associated intestinal and autoimmune diseases characterizes the pediatric population. Association with lymphocytic gastritis, celiac or collagenous sprue, collagenous colitis, and autoimmune disorders are frequently seen in adult patients.
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25
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Abstract
A 25-year-old patient presented with epigastric pain, which on gastric biopsy revealed the characteristic appearance of collagenous gastritis. There was a thick prominent subepithelial band that was confirmed to be collagen with a Masson's trichrome stain. There was associated Helicobacter pylori gastritis but no evidence of a lymphocytic gastritis. The patient did not have watery diarrhea. Collagenous gastritis can occur in young patients, be restricted to the stomach, and can be associated with celiac disease.
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Affiliation(s)
- Richa Jain
- Department of Pathology, University Health Network, University of Toronto, Ontario, Canada
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26
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27
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Ravikumara M, Ramani P, Spray CH. Collagenous gastritis: a case report and review. Eur J Pediatr 2007; 166:769-73. [PMID: 17453238 DOI: 10.1007/s00431-007-0450-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 02/15/2007] [Indexed: 10/23/2022]
Abstract
In this article, we report a case of collagenous gastritis in a child and review the paediatric cases reported to date. Collagenous gastritis is a rare entity, with only less than 30 cases reported so far, including 12 children, since the first description of this entity by Colletti and Trainer in 1989. This is a histological diagnosis characterised by a dramatically thickened subepithelial collagen band in the gastric mucosa associated with an inflammatory infiltrate. Children with this condition often present with epigastric pain and severe anaemia, with no evidence of extragastric involvement, in contrast to the adult patients, where chronic watery diarrhoea is the main presentation due to associated collagenous colitis. A macroscopic pattern of gastritis with nodularity of gastric mucosa, erythema and erosions are characteristic endoscopic findings in paediatric patients. Specific therapy has not been established and resolution of the abnormalities, either endoscopic or histological, has not been documented. In conclusion, collagenous gastritis is a rare entity of unknown aetiology, pathogenesis and prognosis. Gastroenterologists and pathologists need to be aware of this condition when evaluating a child with epigastric pain, anaemia and upper gastrointestinal bleeding, particularly when endoscopy reveals the nodularity of gastric mucosa. The identification, reporting and long-term follow-up of cases will shed more light on this puzzling condition.
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Affiliation(s)
- Madhur Ravikumara
- Department of Gastroenterology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK
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28
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Kamimura K, Kobayashi M, Narisawa R, Watanabe H, Sato Y, Honma T, Sekine A, Aoyagi Y. Collagenous gastritis: endoscopic and pathologic evaluation of the nodularity of gastric mucosa. Dig Dis Sci 2007; 52:995-1000. [PMID: 17342397 DOI: 10.1007/s10620-006-9278-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Accepted: 03/01/2006] [Indexed: 12/15/2022]
Affiliation(s)
- Kenya Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata 951-8122, Japan.
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29
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Abstract
The discovery of Helicobacter pylori and its intimate role in the development of the most common form of chronic gastritis has elicited a much-needed interest in non-neoplastic gastric pathology. This has been paralleled by an increase in upper endoscopic examinations, which allow recognition of novel patterns and distribution of mucosal injury. Numerous attempts at classification have been made, most based on the acuteness or chronicity of gastric mucosal injury. In this review, we will not offer a new classification but present a detailed description of the major clinicopathological entities, based either on the salient morphological features or the underlying aetiologies, i.e. iatrogenic, autoimmune, vascular or idiopathic.
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Affiliation(s)
- A Srivastava
- Department of Pathology, Dartmouth Hitchcock Medical Center and Dartmouth Medical School, Lebanon, NH, USA
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30
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Abstract
Collagenous mucosal inflammatory diseases involve the columnar-lined gastric and intestinal mucosa and have become recognized increasingly as a significant cause of symptomatic morbidity, particularly in middle-aged and elderly women, especially with watery diarrhea. Still, mechanisms involved in the pathogenesis of this diarrhea remain poorly understood and require further elucidation. The prognosis and long-term outcome of these disorders has been documented only to a limited extent. Recent clinical and pathologic studies have indicated that collagenous mucosal inflammatory disease is a more extensive pathologic process that concomitantly may involve several sites in the gastric and intestinal mucosa. The dominant pathologic lesion is a distinct subepithelial hyaline-like deposit that has histochemical and ultrastructural features of collagen overlying a microscopically defined inflammatory process. An intimate relationship with other autoimmune connective tissue disorders is evident, particularly celiac disease. This is intriguing because these collagenous disorders have not been shown to be gluten dependent. Collagenous mucosal inflammatory disorders may represent a relatively unique but generalized inflammatory response to a multitude of causes, including celiac disease, along with a diverse group of pharmacologic agents. Some recent reports have documented treatment success but histopathologic reversal has been more difficult to substantiate owing to the focal, sometimes extensive nature, of this pathologic process.
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Affiliation(s)
- Hugh J Freeman
- Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, Canada.
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31
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Wang HL, Shah AG, Yerian LM, Cohen RD, Hart J. Collagenous gastritis: an unusual association with profound weight loss. Arch Pathol Lab Med 2004; 128:229-32. [PMID: 14736276 DOI: 10.5858/2004-128-229-cgauaw] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Collagenous gastritis is a distinctive disorder characterized by thickening of the subepithelial collagen layer in the gastric mucosa. Although this entity was recognized in 1989, its etiology, pathogenesis, and clinicopathologic features remain poorly understood because of its rarity. An unusual case of collagenous gastritis was observed in a 37-year-old man who presented with profound weight loss, a feature that has not previously been emphasized.
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Affiliation(s)
- Hanlin L Wang
- Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University School of Medicine, St Louis, Mo 63110-1093, USA.
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32
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Abstract
Collagenous gastritis, a counterpart of collagenous colitis, is a rare disorder with less than 20 cases reported in the literature. A case of collagenous gastritis in a Japanese woman in her early 20s who had been receiving treatment for atopic dermatitis and bronchial asthma is reported. The patient complained of repeated epigastric pain, and endoscopy revealed multifocal atrophic areas and scars in the gastric body. Biopsy specimens showed a thickened eosinophilic band-like structure with entrapped capillaries approximately 30-70 micro m thick beneath the surface epithelium. It was regarded as a collagen band because it was positive on Azan staining but negative on amyloid staining. This finding was accompanied by marked infiltration of mononuclear cells and eosinophils in the lamina propria; however, no evidence of lymphocytic gastritis was found. Helicobacter pylori infection was not detected and inflammatory cell infiltration was minimal in the mucosa without the collagen band. Immunohistochemical analysis revealed that the band was positive for type III and type VI collagen. The size of the collagen band did not change for 2 years. These findings suggest that subepithelial collagen deposition was due to an abnormal local immune response based on generalized allergic disorder.
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Affiliation(s)
- Yuri Kajino
- Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Japan
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