Collagenous Gastritis

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.

The various faces of autoimmune endocrinopathies: Non-tumoral hypergastrinemia in a patient with lymphocytic colitis and chronic autoimmune gastritis

“…Rarely, such elevated gastrin levels are seen in patients with pernicious anemia (PA) which most commonly is associated with autoimmune gastritis (AG) (Koch, 2009; Korman et al, 1970; Lewin et al, 1976). AG can occur concomitantly with lymphocytic colitis (LC) (Bohr, 1998; Bohr et al, 1996a; Cindoruk et al, 2002; Koskela et al, 2011; Leung et al, 2009; Pardi et al, 2002a; Remaine, 2000; Rostami et al, 2000; Triantafillidis et al, 2003). In the setting of polyglandular syndromes, other autoimmune diseases including type 1(A) diabetes mellitus, Graves' disease, Hashimoto's thyroiditis, Addison's disease, hypoparathyroidism, lymphocytic hypophysitis, premature ovarian failure, hypogonadism, autoimmune hepatitis, alopecia areata, vitiligo, Sjogren's syndrome, multiple sclerosis, celiac disease, and Crohn's disease may be present or evolving (Betterle et al, 2002; Brown, 2009; Dittmar and Kahaly, 2010; Kahaly, 2009; Koch et al, 2000; Manetti et al, 2007; Melcescu et al, 2010; Michels and Gottlieb, 2010; Mitchell and Pearce, 2012; Triantafillidis et al, 2003; Vrijman et al, 2012).…”

Collagenous Colitis Associated with Protein Losing Enteropathy in a Toddler

“…There is growing evidence in adult literature that collagenous inflammatory mucosal disease is a more extensive pathologic process that concomitantly might involve several other gastrointestinal sites and not only the colon [6, 7]. Searching the pediatric literature revealed more than twenty-four reported patients with collagenous gastritis [8], more than nine cases of collagenous colitis [3–5, 9–14], one with gastrocolonic involvement [11], and one with involvement of gastric, duodenal, and colonic mucosa [15].…”

“…In adults, only 2 cases of CC associated with PLE have been reported [16, 17]. PLE was not part of the clinical presentations in those adult patients who had gastric or small intestinal involvement with CC [6, 7]. …”

An unusual case of collagenous gastritis in a middle- aged woman with systemic lupus erythromatosis: a case report

“…Collagen thickness has been associated with disease duration but not with disease severity. There have been no reports of carcinoma, lymphoma, or definitive dysplasia developing in association with collagenous gastritis [9]. There are no established treatment protocols for collagenous gastroenteritides, including collagenous gastritis, and resolution of the abnormalities either endoscopic or histologic has not been documented.…”