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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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Patel PD, Doucette S, Sanvanson P. Clinical and Pathologic Response to Vedolizumab in a Young Female Patient With Collagenous Gastritis. ACG Case Rep J 2023; 10:e01175. [PMID: 37868366 PMCID: PMC10586841 DOI: 10.14309/crj.0000000000001175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/13/2023] [Indexed: 10/24/2023] Open
Abstract
Collagenous gastritis is a rare form of gastritis that affects both children and adults. The underlying pathophysiology is not well-understood, and as a result, there are limited options for treatment. We report a case of a young female patient with chronic diffuse abdominal pain, nausea, regurgitation, and early satiety with esophagogastroduodenoscopy showing gastric erythema, atrophic gastric body, and significant gastric nodularity. Biopsies revealed focal erosion and increased subepithelial collagen deposition. She was successfully managed with intravenous vedolizumab infusions after initial therapy with topical budesonide did not result in clinical or endoscopic improvement.
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Affiliation(s)
- Paraj D. Patel
- Department of Medicine, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI
| | - Saryn Doucette
- Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Patrick Sanvanson
- Department of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI
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Collagenous Gastritis: Characteristics and Response to Topical Budesonide. Clin Gastroenterol Hepatol 2022; 20:1977-1985.e1. [PMID: 34864160 DOI: 10.1016/j.cgh.2021.11.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Collagenous gastritis (CG) is a rare disorder characterized by subepithelial collagen deposition in the stomach. Standard medications have been only moderately successful in treating CG. We report results of a large, retrospective, open-label noncontrolled study of topical budesonide for CG, with an aim of establishing an alternative therapy for the disease. METHODS We identified patients treated for CG at Mayo Clinic (2000-2017) with topically targeted budesonide (TTB) in 2 formulations: open-capsule budesonide or compounded immediate-release budesonide capsule. Demographic, clinical, biochemical, and histologic variables were assessed for all patients before and after treatment. RESULTS We identified 64 patients with CG (50 adults, 14 children). Most were female (68%), mean age was 41 ± 22.8 years, and body mass index was 23.1 ± 5.9 kg/m2. In most pediatric patients, CG presented with abdominal pain and anemia; in adults, CG presented more often with weight loss (P < .001). Collagenous sprue or colitis were more common in patients >50 years of age (83%) vs those 19-50 years of age (27%) or <19 years of age (50%) (P < .001). Of the patients treated with TTB, 89% had a clinical response to TTB (42% complete, 46% partial), and 88% had a histologic response (53% complete, 33% partial). CONCLUSIONS Adults and children with CG have a wide variety of symptoms, and notably, TTB therapy produced clinical and histologic improvement after other therapy had failed.
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Mishra A, Chung J, Mani H, Serrano M. Response to Mesalamine Therapy in Pediatric Collagenous Gastritis and Colitis: A Case Report and Review. Glob Pediatr Health 2022; 9:2333794X221094262. [PMID: 35465197 PMCID: PMC9021462 DOI: 10.1177/2333794x221094262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/25/2022] [Indexed: 11/16/2022] Open
Abstract
Collagenous gastritis and collagenous colitis are 2 rare gastrointestinal disorders in pediatric patients. Both of these disease processes exist on a clinical spectrum, and are extremely rare to be present together in the pediatric population. Due to the rarity and unknown etiology of these disease processes, standardized treatment protocols and objective clinical biomarkers of disease progression are missing. This is the first report to describe a 16 year old female with CG and CC who responded well to mesalamine therapy, evident by decreasing calprotectin levels after initiation of therapy.
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Affiliation(s)
- Ankit Mishra
- Georgetown University School of Medicine, Washington, DC, USA
| | - Joon Chung
- Georgetown University School of Medicine, Washington, DC, USA
| | - Haresh Mani
- Inova Fairfax Hospital, Falls Church, VA, USA
| | - Mariastella Serrano
- Georgetown University School of Medicine, Washington, DC, USA.,MedStar-Georgetown University Hospital, Washington, DC, USA
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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: 8] [Impact Index Per Article: 2.7] [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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8
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Collagenous Gastritis Masquerading as Eosinophilic Gastritis. ACG Case Rep J 2021; 8:e00527. [PMID: 33634200 PMCID: PMC7901789 DOI: 10.14309/crj.0000000000000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 09/04/2020] [Indexed: 11/17/2022] Open
Abstract
A 11-year-old boy presented to the gastroenterology clinic after a 5-month history of fatigue, pallor, intermittent abdominal pain, and iron-deficiency anemia. Although the initial upper endoscopy was visually normally, the histological assessment was suggestive of eosinophilic gastritis. After multiple scopes and failed therapies, histologic analysis revealed a focus of thickened subepithelial collagen deposition suggestive of collagenous gastritis. A retrospective review of gastric biopsies using Gomori trichrome stain revealed previously unappreciated collagen deposition. This case report illustrates the benefit of performing trichrome stain on gastric biopsies in the setting of persistent or isolated gastric eosinophilia or iron deficiency anemia.
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Eke CB, Brown RA, De Lacy RJ, Pillay K, Goddard EA. Collagenous gastritis: An unusual cause of generalized oedema in a child. J Trop Pediatr 2019; 65:305-308. [PMID: 30085268 DOI: 10.1093/tropej/fmy048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Collagenous gastritis is an uncommon gastrointestinal disease in children. Its cause remains uncertain. It may present as severe hypoproteinaemia manifesting as generalized oedema. We report a 15 months old female who presented with pica, generalized body oedema and diarrhoea. Diagnostic workup revealed gastric replacement of the lamina propria by hyalinized collagen on histology. This case seeks to highlight the need for early paediatric gastroenterology referral including oesophagogastroduodenoscopy with multiple tissue biopsies as part of a broad diagnostic workup in children with non-specific gastrointestinal symptoms to improve diagnostic yield and enable accurate histologic diagnosis, so that appropriate therapy can be timeously applied.
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Affiliation(s)
- Christopher B Eke
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Robin A Brown
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Ronalda J De Lacy
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Komala Pillay
- Department of Pathology, Red Cross War Memorial Children's Hospital, National Health Sciences Laboratories, University of Cape Town, Cape Town, South Africa
| | - Elizabeth A Goddard
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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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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Akkari I, Skandrani K, Abdelkader AB, Mrabet S, Jazia EB. Anemia revealing a collagenous gastritis in a young Tunisian man. Pan Afr Med J 2018; 30:231. [PMID: 30574249 PMCID: PMC6295307 DOI: 10.11604/pamj.2018.30.231.12981] [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] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/06/2018] [Indexed: 12/13/2022] Open
Abstract
Collagenous gastritis is a rare entity, characterized by the deposition of a subepithelial collagenous band with an inflammatory infiltrate in the mucosa. We report the first Tunisian case revealed by severe anemia. Lesions were limited to the stomach and remained unchanged on 3 series biopsies during a 24 month follow up despite treatment with corticosteroids. The cause of the disease remains unknown; our findings suggest that lesions of collagenous gastritis may result from a local immune process.
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Affiliation(s)
- Imen Akkari
- Gastroenterology Department, Farhat Hached Hospital, Sousse, Tunisia
| | - Karim Skandrani
- Gastroenterology Department, Farhat Hached Hospital, Sousse, Tunisia
| | | | - Soumaya Mrabet
- Gastroenterology Department, Farhat Hached Hospital, Sousse, Tunisia
| | - Elhem Ben Jazia
- Gastroenterology Department, Farhat Hached Hospital, Sousse, Tunisia
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12
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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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Appelman MH, de Meij TG, Neefjes-Borst EA, Kneepkens C. Spontaneous Gastric Perforation in a Case of Collagenous Gastritis. APSP J Case Rep 2016; 7:7. [PMID: 26816680 PMCID: PMC4715889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/06/2015] [Indexed: 11/21/2022] Open
Abstract
Collagenous gastritis is an extremely rare disease, both in children and adults. Symptoms vary depending on the extent of collagenous changes in the bowel. In most of the children, iron deficiency anemia and abdominal pain are the presenting symptoms. We present a 15-year-old boy with acute abdomen due to gastric perforation the cause of which was collagenous gastritis.
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Affiliation(s)
- Marly H Appelman
- Department of Paediatric Gastroenterology VU University Medical Centre, Amsterdam, The Netherlands
| | - Tim G.J de Meij
- Department of Paediatric Gastroenterology VU University Medical Centre, Amsterdam, The Netherlands
| | | | - C.M.F Kneepkens
- Department of Paediatric Gastroenterology VU University Medical Centre, Amsterdam, The Netherlands
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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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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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Al-Kandari A, Al-Alardati H, Sayadi H, Al-Judaibi B, Mawardi M. An unusual case of collagenous gastritis in a middle- aged woman with systemic lupus erythromatosis: a case report. J Med Case Rep 2014; 8:278. [PMID: 25135519 PMCID: PMC4144691 DOI: 10.1186/1752-1947-8-278] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/26/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction Collagenous gastritis is a rare histopathologic disease. It is characterized by marked subepithelial collagen deposition with associated inflammatory infiltrate. It is considered an uncommon disease among the general population. Collagenous gastritis without colonic involvement is an extremely rare disease. It is not known to be associated with systemic lupus erythromatosis. This is the first report of this type of association. Case presentation We present a 47-year-old woman from southeast Asia with dyspepsia and mild anemia. Her past medical history was significant for systemic lupus erythromatosis, autoimmune hemolytic anemia as well as hypothyroidism. Her gastroscopy and colonoscopy results were normal from an endoscopic point of view. However, the histopathology showed collagenous gastritis. Conclusions To the best of our knowledge, this is the first case reported of a patient with systemic lupus erythromatosis associated with collagenous gastritis. Further studies are needed to evaluate the association between both diseases from a pathophysiological and immunological perspective.
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Affiliation(s)
| | | | | | - Bandar Al-Judaibi
- Department of Medicine, Division of Gastroenterology, London Health Science Center, The University of Western Ontario, 339 Windermere Road, London, ON N6G 2V4, Canada.
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Nielsen OH, Riis LB, Danese S, Bojesen RD, Soendergaard C. Proximal collagenous gastroenteritides: clinical management. A systematic review. Ann Med 2014; 46:311-7. [PMID: 24716737 DOI: 10.3109/07853890.2014.899102] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIM While collagenous colitis represents the most common form of the collagenous gastroenteritides, the collagenous entities affecting the proximal part of the gastrointestinal tract are much less recognized and possibly overlooked. The aim was to summarize the latest information through a systematic review of collagenous gastritis, collagenous sprue, and a combination thereof. METHOD The search yielded 117 studies which were suitable for inclusion in the systematic review. Excluding repeated cases, 89 case reports and 28 case series were reported, whereas no prospective studies with or without control groups were identified. Further, no randomized, controlled trials were identified. The total number of patients with proximal collagenous gastroenteritides reported was 330. RESULTS An overview of clinical presentations, prognosis, pathophysiology and histopathology, as well as management of these disorders is presented. The prognosis of both collagenous gastritis and sprue seems not to be as dismal as considered previously. Data point to involvement of immune or autoimmune mechanisms potentially driven by luminal antigens initiating the fibroinflammatory condition. CONCLUSIONS To reach the diagnosis it is recommended that biopsies are obtained during gastroduodenoscopies. Therapies with anti-secretory strategies, glucocorticoids, and in some cases iron supplementation are suggested, although rational treatment options from randomized, controlled trials do not exist for these rare or even overlooked disorders.
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Affiliation(s)
- Ole Haagen Nielsen
- Department of Gastroenterology, Medical Section, Herlev Hospital, University of Copenhagen , Denmark
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Tanabe J, Yasumaru M, Tsujimoto M, Iijima H, Hiyama S, Nishio A, Sasayama Y, Kawai N, Oshita M, Abe T, Kawano S. A case of collagenous gastritis resembling nodular gastritis in endoscopic appearance. Clin J Gastroenterol 2013; 6:442-6. [PMID: 26182135 DOI: 10.1007/s12328-013-0431-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 10/01/2013] [Indexed: 02/07/2023]
Abstract
A 25-year-old Japanese female was referred to our clinic for the investigation of moderate iron-deficiency anemia and epigastralgia. Endoscopic examination showed diffuse mucosal nodules in the gastric body resembling nodular gastritis, but this pattern was not observed in the antrum. Histology of the gastric biopsies taken from the gastric body showed mild atrophic mucosa with chronic active inflammation. Some of the biopsy specimens showed deposition of patchy, band-like subepithelial collagen. Four years later, the patient showed no clinical symptoms and signs. A follow-up endoscopic examination showed similar findings, which mimicked pseudopolyposis or a cobblestone-like appearance. The biopsy specimens from the depressed mucosa between the nodules revealed a thickened subepithelial collagen band with no improvement, which led to a diagnosis of collagenous gastritis. Treatment with oral administration of proton-pump inhibitors and histamine-2-receptor antagonists had proved ineffective. To make a correct diagnosis of collagenous gastritis, we should determine the characteristic endoscopic findings and take biopsies from the depressed mucosa between the nodules.
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Affiliation(s)
- Jun Tanabe
- Teramoto Memorial Nishitenma Clinic, AS Building 3F, 3-13-20 Nishitenma, Kita-ku, Osaka, 530-0043, Japan.
| | | | | | - Hideki Iijima
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Satoshi Hiyama
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Nishio
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshiaki Sasayama
- Department of Gastroenterology, Teramoto Memorial Hospital, Kawachinagano, Japan
| | - Naoki Kawai
- Endoscopy Center, Osaka Police Hospital, Osaka, Japan
| | - Masahide Oshita
- Department of Internal Medicine, Osaka Police Hospital, Osaka, Japan
| | - Takashi Abe
- Department of Gastroenterology, Takarazuka Municipal Hospital, Takarazuka, Japan
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Liu X, Xiao SY, Plesec TP, Jiang W, Goldblum JR, Lazenby AJ. Collagenous colitis in children and adolescents: study of 7 cases and literature review. Mod Pathol 2013; 26:881-7. [PMID: 23348901 DOI: 10.1038/modpathol.2012.227] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The aim of this study is to examine the clinical and pathologic characteristics of collagenous colitis (CC) in children and adolescents. Seven patients (five females and two males, median age: 13 years, ranging from 4 to 16) were included. Four (of 7, 57%) patients presented with non-bloody watery diarrhea, one with alternating constipation and diarrhea with rectal prolapse, one with constipation, and one with normal bowel movement. Abdominal pain and weight loss were manifested in 80 and 40% patients, respectively. Two patients had celiac disease in remission. None of the patients took non-steroidal antiinflammatory agents. All patients had normal colonoscopy, but had typical histologic features of CC in colon biopsies. Four patients had clinical follow-up (24-75 months duration, median 54 months): three patients had no gastrointestinal symptoms upon follow-up, but one patient had continued symptoms of alternating diarrhea and constipation. Two patients had follow-up biopsies: one showed persistence of CC, and one had complete histologic resolution. We conclude that while CC is rare in children and adolescents, the clinical presentation is similar to adults, with a female preponderance, presentation with diarrhea and abdominal pain, and an association with celiac disease and other autoimmune disorders. However, compared with adults, children and adolescents are more likely to have weight loss and an atypical presentation including alternating constipation and diarrhea, constipation alone or normal bowel movements. Treatment is less standardized in children and adolescents with CC.
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Affiliation(s)
- Xiuli Liu
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA.
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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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Cerilli LA, Greenson JK. The Differential Diagnosis of Colitis in Endoscopic Biopsy Specimens: A Review Article. Arch Pathol Lab Med 2012; 136:854-64. [DOI: 10.5858/arpa.2012-0205-ra] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—A variety of inflammatory disorders may affect the colon, with widely differing clinical outcomes and management. These conditions encompass a spectrum of acute and chronic conditions.
Objective.—Review the pathology of the major colitides and highlight the most diagnostically useful features.
Data Sources.—Review of recent literature supplemented with personal experience in the field of gastrointestinal pathology.
Conclusions.—The etiologies associated with the various types of colitis are diverse and the range of histologic changes is somewhat limited. Nevertheless, the combination of clinical and endoscopic data coupled with histopathology allows for accurate classification in the majority of cases.
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Affiliation(s)
- Lisa A. Cerilli
- From the Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Joel K. Greenson
- From the Department of Pathology, University of Michigan Medical School, Ann Arbor
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Guo L, Qu LM, Wang YP, Xu H. Collagenous colitis: a report of one case. Shijie Huaren Xiaohua Zazhi 2011; 19:321-323. [DOI: 10.11569/wcjd.v19.i3.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Collagenous colitis is a rare inflammatory bowel disease that is not hard to diagnose but easy to be neglected by physicians. Here we report a case of collagenous colitis. A 71-year-old female patient presented with persistent watery diarrhea. A diagnosis of collagenous colitis was made after multidiscipline consultation. The patient was totally relieved of symptoms after hormone therapy.
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Gopal P, McKenna BJ. The collagenous gastroenteritides: similarities and differences. Arch Pathol Lab Med 2010; 134:1485-9. [PMID: 20923305 DOI: 10.5858/2010-0295-cr.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Collagenous gastritis, collagenous sprue, and collagenous colitis share striking histologic similarities and occur together in some patients. They also share some drug and disease associations. Pediatric cases of collagenous gastritis, however, lack most of these associations. The etiologies of the collagenous gastroenteritides are not known, so it is not clear whether they are similar because they share pathogeneses, or because they indicate a common histologic response to varying injuries. The features, disease and drug associations, and the inquiries into the pathogenesis of these disorders are reviewed.
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Affiliation(s)
- Purva Gopal
- Department of Pathology, University of Michigan, Ann Arbor, USA.
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