June 2017 - Presented by Dr. Pritesh Chaudhari & Dr. Tao Wang


Collagenous gastritis (CG) is a rare idiopathic disorder characterized by the distinctive endoscopic-histopathologic finding of a thickened (> 10 μm) gastric subepithelial collagen layer in association with inflammatory cell infiltrate in the lamina propria. There are over 25-case reports of collagenous gastritis reported worldwide of which 10 are pediatric cases.

Although rare, the literature divides collagenous gastritis into distinct pediatric-onset and adult-onset phenotypes. The classic pattern in children centers around upper gastrointestinal symptoms including abdominal pain and severe anemia. In contrast to the adult phenotype, inflammatory changes and collagenous band deposition is usually limited to stomach and CG has a variable clinical and histopathological response to therapy. Adult type CG is linked with several autoimmune processes and celiac disease which is not seen in the childhood form. As opposed to pediatric-onset collagenous gastritis, the adult-onset form is associated with collagenous colitis and presents clinically with voluminous non-bloody diarrhea.

The etiology of collagenous gastritis is unclear; one hypothesis is a vascular abnormality with increased vascular permeability resulting in deposition of extruded protein and collagen deposition. Alternatively a primary inflammatory process results in a secondary fibrotic scarring process in susceptible individuals.

Treatment of CG in either age group remains poorly defined; treatment strategies have revolved around the etiopathologic observations suggesting an inflammatory process and the association with celiac disease. Both anti-inflammatory and anti-secretory measures as well as gluten free diet have been tried but there has been, to date, no comprehensive review of treatment strategies and outcomes in this population.

In conclusion, collagenous gastritis in children tends to be an isolated process that follows a generally benign course with limited long-term morbidity and no increased mortality reported to date. Clinical investigation in children with collagenous gastritis needs to include investigation for H. Pylori and colonoscopy to rule out collagenous colitis.


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