Case Of Gastritis Research Articles

A Case of Emphysematous Gastritis Caused by Drug Induction

A Case of Emphysematous Gastritis Caused by Drug Induction

Suppurative gastritis as a rare cause of acute abdomen and septic shock in a pregnant woman: a case report

Background: Suppurative or phlegmonous gastritis is an uncommon but serious disease, which can be fatal if untreated. The treatment is conservative at first with antibiotic therapy, but a total gastrectomy might be required if the patient is unresponsive to medical treatment and the clinical conditions deteriorate. Case presentation: We present a case of acute suppurative gastritis, the second in the literature to our knowledge not to be fatal in a pregnant woman, caused by group A Streptococcus pyogenes, treated conservatively after an exploratory laparoscopy. The delivery was uncomplicated and the patient recovered well after a long cycle of targeted antibiotic therapy. Conclusion: The rarity of suppurative gastritis may be associated with the difficulty of a prompt diagnosis and high mortality as a result. The aim of this case report is to raise awareness about the importance of an early diagnosis, and it is crucial to avoid treatment delays. The emergency physician, radiologist, and surgeon should be aware of this entity.

A Case of Eosinophilic Gastritis with Gastric Bleeding

Eosinophilic gastritis is a manifestation of gastrointestinal eosinophilic disease. The clinical symptoms are not specific, similar to other gastric disease complaints. The diagnostic aproach aside from clinical manifestations is also from endoscopic and histopathological features as the gold standard. Management includes drugs and diet. In some cases with strictures and perforations, endoscopic or even surgical intervention needed. Steroid-based therapy, especially topical preparations, is still the main choice. Other alternative therapies such as immunosuppression and targeted therapy showed good results in several case reports and small-scale studies. Further research to get a better management needed, considering the prevalence of this disease is elevated.

A case of hemorrhagic gastritis caused by accidental ingestion of fluoride-containing toothpaste

A case of hemorrhagic gastritis caused by accidental ingestion of fluoride-containing toothpaste

S2096 Curious Case of CMV Gastritis in HIV/AIDS Patient

S2096 Curious Case of CMV Gastritis in HIV/AIDS Patient

S2972 Pembrolizumab-Induced Gastritis Successfully Treated With Vedolizumab

INTRODUCTION: We report a case of histologically-proven gastritis induced by pembrolizumab, a PD-1 inhibitor, successfully treated by vedolizumab. CASE DESCRIPTION/METHODS: A 36-year-old Hispanic female with a history of left breast invasive ductal carcinoma on pembrolizumab presented to oncology clinic with 3 weeks of worsening burning stomach pain. Patient had been receiving pembrolizumab, a PD-1 inhibitor, for 10 months experiencing only grade 1 fatigue, xerostomia, and rash. She also described abdominal bloating that occurred before and after meals. She endorsed a 10 lb weight loss over 1 month but denied fevers, melena, nausea and vomiting. On exam, abdomen was benign and non-tender. Serology labs were unremarkable. After failing empiric PPI therapy, CT scan was ordered showing enlarged peri-gastric lymphadenopathy prompting GI consultation. EGD found diffuse gastritis with friability, erythema and mucosal sloughing. Histology showed chronic active gastritis suggestive of immunotherapy-induced gastritis. She was initially started on prednisone 50mg daily which improved her symptoms minimally; therefore, she received 5 doses of vedolizumab over 6 months resulting in a marked improvement of her upper GI symptoms and increased PO tolerance over the next year. A follow-up EGD and biopsy 8 months later showed normal visualization of the stomach and histology consistent with chronic inactive gastritis. DISCUSSION: Immune-checkpoint inhibitor (ICI) colitis is a well-known adverse event of immunotherapy; however, upper GI manifestations are less commonly reported thus making our patient’s presentation unique. Vedolizumab, an antibody against the α4β7-integrin blocking gut homing lymphocytes, is approved for the treatment of inflammatory bowel diseases and has shown efficacy in treating steroid-refractory ICI colitis.1 Here, we added to growing evidence that vedolizumab may be an effective treatment for steroid-refractory upper GI adverse effects from immunotherapy;2 further studies with larger cohorts of patients are warranted to evaluate safety and efficacy of vedolizumab use in this context.

S3024 No Dermatologist Needed for This Collagen Filler: The Rare Presentation of Collagenous Gastritis in a Patient With Eosinophilic Esophagitis

INTRODUCTION: Collagenous gastritis is a rare disease characterized by subepithelial collagen deposits within the gastric mucosa and chronic inflammation. While this disorder has similar histologic characteristics to the more common collagenous colitis, little is known about collagenous gastritis given its rarity. Fewer than 100 cases of collagenous gastritis have been reported to date, and our understanding of the disease is limited. The disease typically manifests with nonspecific symptoms including abdominal pain, diarrhea, and iron deficiency anemia (IDA). It is diagnosed histologically, and has been linked to various autoimmune disorders. We will describe a case of collagenous gastritis to further knowledge of this rare disease. CASE DESCRIPTION/METHODS: A 32-year-old man with a history of partial right lower lobectomy for carcinoid tumor 11 years prior, was referred for IDA, upper abdominal pain, and dysphagia. Initial endoscopy with biopsies revealed esophageal eosinophilia, consistent with eosinophilic esophagitis ( EoE). Gastroduodenal biopsies were unremarkable, and colonic biopsies revealed no collagenous or lymphocytic colitis. He was started on a PPI for 8-weeks and iron supplements, with improvement of symptoms. Following treatment, repeat EGD demonstrated resolution of his esophageal eosinophilia, and iron supplementation was discontinued. He re-presented 2 years later, with similar symptoms and recurrence of IDA. Repeat EGD demonstrated esophageal eosinophilia consistent with EoE. Endoscopy also revealed gastric erythema with nodularity (Figure 1), and subepithelial collagen deposition within the gastric body and fundus, consistent with collagenous gastritis (Fig 2a, 2b). He was restarted on iron supplement and a PPI, with improvement of symptoms. DISCUSSION: Collagenous gastritis has been associated with autoimmune disorders, and may be linked to EoE as described in this case. While diagnosis is histological, endoscopic features include gastric mucosal nodularity and erythema. Currently there is no clear consensus on the treatment of collagenous gastritis. Multiple therapies have been attempted including acid suppression, iron supplementation, hypoallergenic diets, among others, however to date there are no randomized control trials demonstrating treatment efficacy, and overall prognosis remains unclear. Awareness of this disorder is essential in its recognition. More information is needed to understand collagenous gastritis and determine how best to treat patients affected by this rare disease.Figure 1.: Endoscopic view of the gastric body, depicting moderately erythematous mucosa, with slight mucosal nodularity as seen (arrow).Figure 2a.: Gastric antrum/body endoscopic biopsy demonstrating thickened subepithelial collagen deposition (arrow) and inactive chronic gastritis. (H&E stain, 200x).Figure 2b.: Gastric antrum/body endoscopic biopsy with trichrome stain, demonstrating thickened subepithelial collagen. (Trichrome stain 2A, 200x).

S2944 A Rare Disease Caused by Treatment of a Common Problem

INTRODUCTION: Collagenous gastritis (CG) is a histologic diagnosis that is defined as subepithelial thickening to >10 μm due to the deposition of collagen tissue. It is a rare disease with unclear etiology but has strong association with autoimmune diseases. We present a case of collagenous gastritis induced by Olmesartan. CASE DESCRIPTION/METHODS: A 62- years-old woman with hypertension presented with nausea, epigastric pain, weight loss, and odd-tasting saliva for 1 month. Pertinent physical examination revealed normal vital signs and tenderness of the epigastric area without signs of peritonitis. Workup for all potential infectious causes and celiac disease was negative. An upper endoscopy showed gastritis with umbilications in the antrum and gastric mucosal atrophy in the gastric body and fundus. Gastric histopathology revealed collagenous gastritis with mucosal atrophy and eosinophilic infiltrate without intestinal metaplasia (Figure 1). Duodenal biopsy revealed preserved villi. In light of negative celiac disease and after review of the patient’s medication, the diagnosis of Olmesartan induced collagenous gastritis was considered. Olmesartan was discontinued and her symptoms resolved. Two months later her weight had returned to normal. DISCUSSION: Olmesartan associated collagenous gastritis (OACG) is a rare disease that was initially reported in 2012. In adults, OACG without small and/or large bowel involvement is exceptionally rare. Presenting symptoms are abdominal pain, nausea, vomiting, weight loss, and anemia. Symptoms develop months to years after the initiation of olmesartan therapy. The presumptive diagnosis of OACG is made in patients who develop symptoms while taking olmesartan with a supportive histologic finding on gastrointestinal biopsies. Discontinuation of olmesartan has been the mainstay of treatment.Figure 1.: High power view: Thickened basement membrane (green arrow), and eosinophils (red arrow), lymphoplasmacytic infiltrate (white arrows head).

Corrosive Esophagitis and Gastritis Induced by Glutaraldehyde Ingestion

Corrosive esophagitis and gastritis are characterized by caustic damage due to ingestion of chemical agents. Caustic agents cause tissue destruction through liquefaction or coagulation reactions. Here, we report a case of corrosive esophagitis and gastritis caused by accidental ingestion of glutaraldehyde in Korea. A 62-year-old man presented to the emergency department 8 hours after ingesting glutaraldehyde, which is widely used for the prevention of foot-and-mouth disease in pigs. Urgent endoscopic examination revealed severely damaged mucosae of the esophagus and stomach. With conservative treatment, the patient’s condition was improved, and he was discharged on the 35th day of admission.

Intravitreal aflibercept for management of choroidal neovascularization secondary to angioid streaks : The Italian EYLEA-STRIE study.

To investigate the effect and the safety of intravitreal aflibercept in patients affected by choroidal neovascularization secondary to angioid streaks with a long-term follow-up. Multicentre, open-label, phase IIb study (EYLEA-STRIE, EudraCT Number 2014-000986-30) involving four Italian centres (IRCCS Ospedale San Raffaele (Milano), Fondazione G.B. Bietti (Roma), Policlinico (Milano), Ospedale Luigi Sacco (Milano)). Patients with active choroidal neovascularization secondary to angioid streaks with foveal involvement were prospectively enrolled and followed for 18months. All the patients received intravitreal 2mg/0.05 mL aflibercept at the time of enrolment, followed by a pro-re-nata regimen for 48weeks. Best-corrected visual acuity and central macular thickness were measured monthly. Adverse events were monitored at each visit. Twenty-three eyes of 20 patients were analysed. Mean number of injections per patient was 4.30 ± 1.2. At week 48, the best-corrected visual acuity was 0.42 ± 0.40 LogMAR (p = 0.6 from baseline) and 18 eyes (81.8%) featured stability within 15 letters. The central macular thickness significantly reduced (p = 0.03). Eleven ocular non-serious adverse events and two serious adverse events were observed (one case of endophthalmitis and one case of acute gastritis were reported). Intravitreal aflibercept represents a valid option for the management of choroidal neovascularization complicating angioid streaks. Further studies with longer follow-up and different therapeutic regimens are warranted to ascertain the best control of the disease.

Emphysematous Gastritis Worsened after Upper Endoscopy

Emphysematous gastritis is an infectious disease in which air is formed in the gastric wall by gas-forming organisms. It is infrequently reported but can be fatal without early diagnosis and treatment. The stomach is rarely infected because of the acidity of the gastric secretions and the rich blood supply. Treatment should be aimed at covering gram-negative organisms and anaerobes using broad-spectrum intravenous antibiotics, and occasional surgical management in order to enhance survival. Risk factors are those that lead to disrupted mucosal integrity, such as corrosive injury, and those that result in an immunosuppressed condition, including diabetes mellitus, chronic kidney disease, immunosuppressive drug use, and subsequent invasion by gas-forming organisms. We experienced a case of emphysematous gastritis that worsened after endoscopy. Aeration during upper endoscopy examination can cause barotrauma to the gastric wall with impairment of the mucosal barrier, resulting in the spread of gastric wall infection to the whole body. Therefore, we report this case and provide relevant literature review to suggest that early endoscopic evaluation can lead to exacerbation of emphysematous gastritis.

Early total gastrectomy in emphysematous gastritis

AbstractEmphysematous gastritis is a rare form of lethal infection caused by gas‐forming organisms arising from local spread through the gastric mucosa or hematogenous dissemination from a distal focus. It is the counterpart of ischemic bowel disease happening in the stomach. No definitive mode of treatment has been advocated despite its high mortality. Thus far, only 41 cases have been reported in the literature since Dr. Frankel first reported it in 1889. To further understand the disease, we present a case of emphysematous gastritis in a 74‐year‐old female uremic patient, further afflicted with diabetes mellitus, chronic decubitus ulcers, and peripheral occlusive arterial disease, manifesting with fever and sudden loss of consciousness without physical signs of peritonitis. She was diagnosed via computed tomography scan, which showed pneumatosis around the stomach wall, pneumoporta, and pneumoperitoneum. She underwent total gastrectomy within 24 hours, revealing edematous gastric wall and hemorrhagic necroses over the fundus and antrum. Postoperatively, she gradually improved with respirator support, total parenteral nutrition, and broad‐spectrum antibiotics, and she was discharged after 33 days of hospitalization without anastomotic leaks. Further follow‐up revealed that she survived for one and a half years following her surgery without developing a new intra‐abdominal incident, albeit with frequent hospitalizations due to her continuing chronic medical problems. Early aggressive total gastrectomy may be tried to reverse the morbid course of the disease.

A case report of intestinal obstruction due to magnetic ball ingestion

Background: Toys with magnetic balls and objects can lead to serious consequences in children. We report a child with a history of magic ball (magnetic toy) ingestion. Case Presentation: A 4-years-old girl, previously healthy and developmentally normal, presented to the emergency department of the hospital with a 10 days’ history of vomiting and abdominal pain. Parents took her to different hospitals, where she was treated as a case of acute gastroenteritis and gastritis. Routine laboratory tests were normal, and an abdominal ultrasound also did not reveal any abnormality. Parents also did not report anything unusual in history. An abdominal X-ray was done in the Emergency room, which showed a collection of approximately 18 rounded radiopaque objects in the right lower abdomen with the signs of intestinal obstruction. Magnetic balls were removed after laparotomy followed by uneventful recovery. Conclusion: Awareness about the serious consequences of magnetic toy ingestion and the need to supervise children while playing is emphasized. It is strongly recommended that to reduce further damage, the International Safety Standards for the use of small magnets should be established.

Failure of three Recommended Regimens to Treat a Case of Gastritis Caused by Helicobacter pylori

Helicobacter pylori (H. pylori) is a gram-negative pathogen that leads to chronic bacterial infection. Approximately, 50% of the world’s population is affecting even though the precise route of transmission is not known. Up to 90% of people infected with H. pylori never experience symptoms or complications and the majority remains asymptomatic. Treatment failure can occur and physician must deal with case as recommended by guidelines. This report describes the management of a man with gastritis caused by H. pylori that was failed to the three recommended regimens. The patient was initially (first visit) diagnosed as a case of stomach pain (irritation) due to spicy/chilly food. Then the patient was followed regularly up to six visits approximately for 25 weeks with clinical and laboratory assessment provided by medical prescription of recommended regimens. This paper has been reported to describe an unexpected beneficial response to treatment, report unlabeled or unapproved uses of medication and show a positive personal impact despite, the lack of advanced medical facility.

2734 Immunotherapy-Mediated Hemorrhagic Gastritis After Ipilimumab and Nivolumab Therapy

INTRODUCTION: Combined checkpoint inhibitor immunotherapy with ipilimumab (anti-cytotoxic T-lymphocyte antigen 4 antibody) and nivolumab (anti-programmed cell death receptor 1 antibody) has greatly advanced the treatment of multiple malignancies but is associated with increased immune-related toxicities. Gastrointestinal toxicity is one of the most frequent adverse effects, and while lower GI tract toxicity, such as anti-CTLA-4-mediated colitis, is well known, severe toxicity of the upper GI tract is rare and not well described. We report a case of severe hemorrhagic gastritis in a patient after initiation of ipilimumab and nivolumab therapy for metastatic renal cell carcinoma. CASE DESCRIPTION/METHODS: A 70-year-old man with history of metastatic renal cell carcinoma and recent immune-related myocarditis initially presented with myasthenic weakness after receiving single doses of ipilimumab and nivolumab 5 weeks prior. His presentation was most consistent with seronegative, immune-mediated myasthenia gravis-like syndrome. He was treated with intravenous steroids and plasmapheresis. After 9 days of steroid therapy, he developed large volume melena requiring 4 units of blood despite twice-daily proton pump inhibitor therapy. Endoscopic evaluation revealed diffuse, severe inflammation with hemorrhage characterized by adherent blood and erythematous, friable gastric mucosa in the body, antrum, and prepyloric regions. Hemostatic spray was applied as a temporizing measure to control bleeding. Biopsy specimens demonstrated neutrophilic microabscesses with intraglandular apoptotic bodies, increased lymphocytes and scattered neutrophils in lamina propria, and reactive mucosal features. These findings were compatible with checkpoint inhibitor-induced acute gastritis. Immunohistochemical stains for H. pylori and cytomegalovirus were negative. Despite immunosuppressive therapy with high dose steroids, mycophenalate mofetil, and trial of infliximab, he continued to decline with ongoing anemia and progressive weakness. He was transitioned to comfort measures and died soon afterward. DISCUSSION: To our knowledge, this is the first reported case of severe hemorrhagic, non-infectious gastritis as a rare complication of immunotherapy with ipilimumab and nivolumab. Physicians should be aware that checkpoint inhibitor-induced toxicity of the upper GI tract can occur early after initiation of therapy and have a severe, refractory course. Management includes exclusion of infectious process and immunosuppressive therapy.

1573 Ixekizumab-Induced Gastritis and Colitis in an Elderly Female With Plaque Psoriasis

INTRODUCTION: Psoriasis and inflammatory bowel disease (IBD) share common pathogenesis pathways including cytokine mediated inflammation. Interleukin-17 (IL-17) monoclonal antibodies such as ixekizumab have demonstrated excellent results in moderate to severe plaque psoriasis and psoriatic arthritis. Antagonism of IL-17 has been demonstrated in animal models to induce or worsen existing inflammatory colitis. We hereby present a case of ixekizumab-induced gastritis and colitis in a 63-year old Caucasian female with severe plaque psoriasis successfully treated with prednisone. CASE DESCRIPTION/METHODS: A 63-year old Caucasian female with history of severe plaque psoriasis and peptic strictures presented with severe bloody diarrhea, generalized abdominal pain, and tenesmus few weeks after receiving 3 doses of ixekizumab. She had no personal or family history of IBD. Her medications included 81-mg ASA, omeprazole, metoprolol, cetirizine and levothyroxine. She denied NSAID use. A colonscopy 2-years prior showed two tubular adenomas, and a gastroscopy 3 months prior to ixekizumab therapy was normal. Her diagnostic evaluation revealed (a) normal CBC, kidney function and liver chemistries, (b) negative stool cultures, microscopy and C. Difficile testing, (c) a gastroscopy demonstrating diffuse gastritis involving the body and antrum (d) a flexible sigmoidoscopy demonstrating a diffuse area of atrophic, eroded and friable mucosa with contact bleeding and thickened mucosal folds in the recto-sigmoid colon. Gastric and colonic biopsies demonstrated focal mucosal erosions with architectural distortion concerning for a drug induced gastritis and colitis. H. Pylori testing was negative. Ixekizumab was discontinued and treatment with IV steroids was started. Symptom resolution was noted by day five of therapy and she was converted to an oral steroid taper. DISCUSSION: The temporal association, the histology and the improvement with discontinuation of the medication strongly support the diagnosis of a drug induced colitis. This case is unique in the sense that it is the first in the literature to report ixekizumab-induced gastritis and colitis. Whether the patient will require long-term immunosuppression and will manifest later with IBD is to be observed. Despite the rarity of colitis associated with IL-17 inhibitors, counseling patients on this severe adverse effect is integral to the discussion between specialists and their patients prior to initiating therapy.

2681 Emphysematous Gastritis: A Rare Consequence of Small Bowel Obstruction

INTRODUCTION: Emphysematous gastritis is a rare form of gastritis that is characterized by presence of gas in the gastric wall and portal venous system. Prompt diagnosis along with early treatment is key in preventing fatal outcome. Etiology can be ingestion, infectious, mechanical, or ischemic with high mortality. We present a case of emphysematous gastritis in a patient with small bowel obstruction presenting with hematemesis. CASE DESCRIPTION/METHODS: A 70 year African American female with past medical history significant for HTN and Atrial Fibrillation (anticoagulated with Eliquis) presented with complaint of epigastric pain and hematemesis. CT abdomen/Pelvis without contrast showed acute high grade small bowel obstruction at the distal ileum, non-obstructing umbilical hernia and stomach distention with emphysematous gastritis with air in the portal venous system. Patient was hemodynamically stable. Laboratory findings with hemoglobin 13.0 g/dL (11.0-16.2 g/dL), mean corpuscular volume 76.7 fl (80.0—100.0 fl), platelet count 138 K/cmm(140-440L/cmm), white blood cell count 8.2 K/ccm (4.5-11.0 L/cmm) with 32% segmented neutrophils.Patient underwent exploratory laparotomy with release of small bowel obstruction and primary repair of umbilical hernia. Intraoperative Esophagogastrodudenoscopy (EGD) showed diffuse erythema and ulceration in the esophagus, areas of black/purple mucosal discoloration in the gastric cardia, fundus and body with clear demarcation of abnormal and normal tissue at body/antrum. Pylorus was patent with unremarkable first and second part of the duodenum. Findings were consistent with emphysematous gastritis. Patient tolerated the procedure well and was extubated without any hemodynamic decompensation. Broad spectrum antibiotics which were initiated were stopped as blood cultures x 2 had no growth. Patient was discharged from hospital on post op day four with Pantoprazole 40 mg twice daily and follow up endoscopy. DISCUSSION: Emphysematous gastritis is a condition with very high mortality rate of 50-80%. No standardized/definitive approach has been described in the literature though many cases do undergo prompt surgical exploration. Our case portrays a multidisciplinary approach to management of emphysematous gastritis with exploratory laparotomy for small bowel obstruction and intraoperative endoscopy without any need for resection or manipulation of effected area.

2701 Not Your Usual Gastritis: A Case Report of Pembrolizumab-Induced Lymphocytic Gastritis

INTRODUCTION: Pembrolizumab induces immune checkpoint inhibition of programmed cell death protein-1 (PD-1 inhibitors) in various malignancies. Toxicities have been described, including but not limited to, inflammatory reaction in any system, and infusion related side effects. We report a rare case of symptomatic lymphocytic gastritis after pembrolizumab treatment of vocal cord squamous cell carcinoma. CASE DESCRIPTION/METHODS: 70 year old female with history of right true vocal cord squamous cell carcinoma status post excision and chemoradiation with cisplatin. Recurrence in 1 year to the anterior vocal cord prompted treatment with pembrolizumab. Patient suffered complete esophageal occlusion requiring multiple EGDs with dilatation, gastric tube placement, morphine and transcutaneous fentanyl analgesia. During pembrolizumab treatment she developed new onset nausea and vomiting, intolerance to feeding regimen for 3 weeks, and a 10 pound weight loss in 1 week but no change in bowel movements, melena, abdominal pain, or fever. Physical exam was significant for cachectic female, LUQ G-tube in situ with no erythema/discharge, no abdominal tenderness, rigidity, or organomegaly, normal bowel sounds, and normal rectal exam. Lab work up was not significant. EGD was performed showing diffuse erythematous mucosa in the entire examined stomach. Biopsy showed lymphocytic gastritis negative for metaplasia, dysplasia, or neoplasia with no H-Pylori or other infectious organisms. Patient was started on prednisone 60mg daily with slow taper, metoclopramide, ondansetron PRN, and pembrolizumab was stopped. GI symptoms improved significantly with resolution of emesis. DISCUSSION: Lymphocytic gastritis (LG) is a rare subtype linked with H-pylori infection, celiac, lymphoma, and medication side effect. Patient might be asymptomatic or exhibit dyspepsia, nausea, vomiting or weight loss. Work up includes EGD; however, endoscopic appearance can be nonspecific as patients might have erythema, erosions, nodules or normal appearing mucosa. Diagnosis is made when biopsies show intraepithelial lymphocytes with more than 25 in 100 epithelial cells. Recommended treatment is based on etiology and included removing the offending agent, H-pylori eradication and/or gluten free diet. Steroids are not usually considered in the treatment of LG, but they are proposed as first line therapy in treatment of PD-1 inhibitor related side effects (enteritis, colitis, etc). Our patient had good response to steroids as her LG was induced by PD-1 inhibitor.

2759 Eosinophilic Gastritis Responding to Proton Pump Inhibitor

INTRODUCTION: Eosinophilic gastritis is a rare condition that is part of a spectrum of gastrointestinal eosinophilic infiltration disorders which also includes eosinophilic esophagitis, enteritis, and colitis. They are characterized by excess eosinophils in the mucosal biopsy of one or more sites of the gastrointestinal tract in the absence of any specific causes of eosinophilia. Patients may present with symptoms including nausea, vomiting, abdominal pain, and weight loss. First-line of treatment is steroids. We describe a case of eosinophilic gastritis that was successfully treated with Proton pump inhibitor therapy. CASE DESCRIPTION/METHODS: A 23-year-old male presented to the outpatient clinic with a six-month history of episodic epigastric discomfort and retrosternal burning pain. Each episode lasted several hours and was precipitated by food intake. He had previously taken omeprazole 10 mg on and off for 4 weeks without any response. He had no history of any allergic disease. H.pylori stool antigen was negative. He was subsequently treated with four-week therapy of tricyclic anti-depressants with no response. Following this, he underwent upper gastrointestinal (UGI) endoscopy which showed mild erythema in the antrum. Gastric biopsy showed extensive eosinophilic infiltration with >50 cells/HPF in >5 HPF with normal esophageal and duodenal biopsy. Differential WBC count showed mild eosinophilia (7%). In line with a diagnosis of eosinophilic gastritis the patient was advised six food elimination which he refused. He was then started on Pantoprazole 40 mg once daily which was increased to twice daily after a week due to continued reflux symptoms. His symptoms gradually resolved over the next 12 weeks. On follow-up visit 3 months later he underwent repeat UGI endoscopy with biopsy which showed complete resolution of eosinophilic gastritis. The patient continues to remain asymptomatic. DISCUSSION: Eosinophilic gastrointestinal disorders can involve any part of the gastrointestinal tract from the esophagus to the colon. The antrum of the stomach is most commonly involved. There are no recognized guidelines for the treatment of eosinophilic gastritis, although steroid therapy is the mainstay of treatment. The role of PPI in the treatment of eosinophilic esophagitis is well known, but the utility of the same in eosinophilic gastritis has not been well defined. Our patient had symptomatic gastritis with biopsy revealing extensive eosinophilic infiltration. He responded excellently to 12-week pantoprazole therapy.

2686 Collagenous Gastritis: A Rare Entity

INTRODUCTION: Collagenous gastritis is a rare entity characterized by subepithelial deposition of collagen bands thicker than 10 μm and the infiltration of inflammatory mononuclear cells in the lamnia propia. While collagenous colitis has become more common in clinical practice, collagenous gastritis is rare. These two entities generally present differently. Collagenous colitis presents more commonly with diarrhea, while collagenous gastritis presents more commonly with abdominal pain. Since the disease was reported in 1989, only 60 cases have been documented in English literature. We present a case of collagenous gastritis in a pediatric patient. CASE DESCRIPTION/METHODS: A 17-year-old male patient presents to our office with a three month history of epigastric pain with no changes in bowel habits. He denies any previous past medical or surgical history. He immigrated to the United States from China. Physical examination was unremarkable aside from mild epigastric tenderness. A CMP, CBC and celiac serologies were unremarkable. Upper endoscopy was performed which revealed moderate erythematous mucosa in the gastric antrum (Figures 1 and 2). Biopsies of the antrum yielded mild chronic gastritis with sub-epithelial collagenous gastritis in the antrum (Figure 3). Helicobacter Pylori was negative. Patient symptoms gradually responded to a proton pump inhibitor. DISCUSSION: Collagenous gastritis is a rare condition with limited data in the literature. Most patients are young, abdominal pain and anemia occur secondary to stomach-specific infiltration. The etiology is mostly unknown and hypothesized. The endoscopic findings that are commonly reported include nodular changes in the mucosa, due to chronic inflammatory infiltration, mucosal atrophy and deposition of bands of collagen. Compared with the diffuse and continuous deposition seen in collagenous colitis, the changes in collagenous gastritis are heterogenous. Collagenous gastritis as a rare entity should be in the differential in younger patients who present with epigastric pain.