Abstract
BACKGROUND: Collagenous gastritis (CG) is a rare condition, characterized by gastric subepithelial collagen bands greater than 10 μm with an inflammatory cell infiltrate within the lamina propria. There is limited understanding of its pathogenesis. Pediatric patients present with anemia and abdominal pain, while adults present with diarrhea associated with collagenous colitis or celiac disease. The natural history of this condition is unknown. AIMS: Case series was performed to describe the clinical, endoscopic and histologic features and evolution of children with collagenous gastritis. METHODS: Chart reviews were conducted on 6 children diagnosed with collagenous gastritis at BC Children’s Hospital between 2007 and 2016. Demographic, clinical, endoscopic, and histologic details were collected. RESULTS: Case details are summarized in Table 1. The series included 4 females and 2 males. All patients underwent at least one upper endoscopy and 2 underwent multiple upper endoscopies. Two patients had colonoscopy performed and another underwent capsule endoscopy, all of which were normal. Anemia was the primary presentation in 5 of 6 patients. Other symptoms included abdominal pain (2/6), vomiting (2/6) and hematemesis (1/6). All patients tested negative for H. pylori via CLO test on biopsy. Five out of 6 patients underwent serologic testing for celiac disease, which was negative. Macroscopic findings most commonly included gastric mucosal nodularity followed by erythema, erosions and ulcers. Histology confirmed collagenous gastritis. Two patients also had collagenous duodenitis. Patient 3 was initially diagnosed with eosinophilic gastritis. Subsequent endoscopy demonstrated collagenous gastritis on biopsy. Patient 6 had gastric and antral eosinophilia in addition to gastroduodenitis. Duration of follow-up ranged from 3 months to 3 years. Treatments for these patients included iron (5/6), budesonide (3/6), and proton pump inhibitor (1/6). All patients either had borderline normal or low ferritin on follow-up, and 2 patients continued to have iron deficiency anemia. Of the 2 patients who had follow-up biopsies, neither had endoscopic or histologic improvement. CONCLUSIONS: Collagenous gastritis is a chronic condition in children. A precursor lesion may be chronic active gastritis with gastric eosinophilia, followed by formation of a subepithelial band of collagen. The endoscopic and histologic evolution warrants further characterization. Anemia and chronic active gastritis may suggest the possibility of developing collagenous gastritis, after common causes are excluded. Current treatments for collagenous gastritis do not appear to alter its course. FUNDING AGENCIES: None