Abstract
A 9-year-old girl presented with a long history of tiredness, lethargy, weight loss and slow growth. She had iron deficiency anaemia, responsive to oral iron therapy. An endoscopy showed a nodular polypoid appearing stomach with a pedunculated polyp in the antrum. Biopsies showed features of collagenous gastritis with thickened subepithelial collagen band associated with mixed chronic inflammation and atrophy. The polyp contained collagen filling the lamina propria with smooth muscle fibres extending up from the muscularis mucosa towards the lamina propria and mucosa. Focal intraepithelial lymphocytes were seen in the small bowel. The large bowel was unremarkable. Collagenous gastritis is a rare entity first described in 1989 by Colletti and Trainer, and is characterised by subepithelial collagen band greater than 10µm in thickness. Two subsets of patients have been described: (1) children and young adults with severe anaemia and disease limited to the gastric mucosa without colonic involvement, and (2) older adults with watery diarrhoea and collagenous gastritis associated with collagenous colitis. It may also be associated with collagenous duodenitis, lymphocytic colitis, celiac and collagenous sprue.It is an important entity to recognise. There is usually no effective treatment and patients require long-term follow-up.
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