Collagenous Gastritis

Abstract

Purpose: Collagenous Gastritis is a histological diagnosis characterized by a dramatically thickened subepithelial collagen band in the gastric mucosa associated with an inflammatory infiltrate. Children usually present with epigastric pain with severe anemia as compared to adults who present with chronic watery diarrhea attributed to concomitant collagenous colitis. Collagenous Gastritis is a rare entity with less than 35 cases reported thus far. We report a case of Collagenous Gastritis in a teenager presenting as abdominal pain and anemia. Methods: 17 year old Iraqi female, with a one year history of profound anemia, presented with intermittent lower abdominal pain for the last 1 year. Pain typically occurred every 2–3 days. This was associated with intermittent loose stools 5–6 times daily. Occasional nausea was reported but review of systems was negative for anorexia, weight loss, hematemesis, melena or hematochezia. No recent antibiotics or travel history was provided. Physical examination was essentially unremarkable. Laboratory evaluation revealed a hemoglobin of 12.1 g/dl which was on iron supplementation in comparison to a hemoglobin of 7.0 g/dl noted a year prior. Biochemical profile, C-Reactive Protein and Celiac panel were all within normal limits. Patient underwent an upper endoscopy which revealed diffuse erythematous mucosa of the whole stomach. Biopsies were taken and revealed a markedly thickened subepithelial band of collagen (basement membrane) with variable thickness (about 40–95 microns. Moderate chronic infiltrate was noted in the lamina propria. These findings were suggestive of Collagenous Gastritis. Results: Not Applicable Conclusion: Collagenous gastritis is a rare entity of unknown etiology, pathogenesis and prognosis. Gastroenterologists and pathologists need to be aware of this condition when evaluating adolescents with abdominal pain, anemia and chronic diarrhea, particularly when endoscopy reveals nodularity of gastric mucosa. The identification, reporting and long-term follow-up of cases will shed more light on the prognosis and management of this puzzling condition.