Ahmad Abulawi, MBBS1, Asra Batool, MD2 1Albany Medical College, Albany, NY; 2Albany Medical Center, Albany, NY
Introduction: Collagenous gastritis is a rare disease of unknown etiology. It is subdivided into two groups: a pediatric-onset and an adult-onset group. The clinical presentation differs between the two groups: the pediatric-onset group usually presents with abdominal pain and iron deficiency anemia. The Adult-onset group is typically associated with collagenous colitis and autoimmune diseases. Here, we are reporting a case of isolated collagenous gastritis in the adult age group.
Case Description/Methods: A 20-year-old male presented complaining of postprandial epigastric abdominal pain associated with occasional melena, and hematochezia. The physical exam was remarkable for mild epigastric tenderness. Investigation revealed hemoglobin of 10 g/dl, MCV 75.3 fL, iron saturation of 6%, and ferritin 5 ng/ml. Anti-tissue transglutaminase was negative. Upper endoscopy revealed congested, nodular stomach mucosa with erosions and erythema. There was a patchy distribution of prominent subepithelial collagen deposition and an expanded inflammatory infiltrate in the lamina propria on biopsies, and negative for H.Pylori. Duodenal biopsies were negative for celiac disease. Colonoscopy showed no abnormalities including biopsies. The patient was started on Omeprazole 40 mg twice daily and iron supplements. On a follow-up visit, he reported resolution of his symptoms and marked improvement in his iron stores.
Discussion: Collagenous gastritis is characterized by collagen deposition in the sub epithelium, especially the lamina propria, with chronic inflammation consistent with eosinophils, plasma cells, and lymphocytes. The etiology of the disease is still unclear. This disease is divided into two subgroups given the difference in phenotype between the pediatric-onset and adult-onset type. Pediatric cases present with abdominal pain, iron deficiency anemia, and isolated gastric involvement. However, adult patients present with chronic watery diarrhea as the disease is usually associated with collagenous colitis. Also, the adult group is associated with autoimmune disorders. However, our patient was in the adult age group but he manifested symptoms of pediatric patients likely because of his young transitional age.
The characteristic endoscopic finding is nodular mucosa. Therapy is challenging in collagenous gastritis with no established standard of care. Omeprazole has been reported to be effective in relieving symptoms. Iron supplementation is necessary in case of iron deficiency anemia. Close follow-up is encouraged.
Figure: Figure 1. A. & B. showing patchy moderate inflammation characterized by erosions, erythema, and granularity was found in the gastric body.
Disclosures: Ahmad Abulawi indicated no relevant financial relationships. Asra Batool indicated no relevant financial relationships.
Ahmad Abulawi, MBBS1, Asra Batool, MD2. P3112 - A Rare Case of Isolated Collagenous Gastritis in the Adult Age Group, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.