George Washington University School of Medicine and Health Sciences Washington, DC, United States
Jacyln E. Kagihara, MD1, Julia L. Boland, MD1, Sally E. Balkovic, NP-C, DNP1, Divya Mamilla, MD2, Mamoun Younes, MD2, Marie L. Borum, MD, EdD, MPH1, Samuel A. Schueler, MD1 1George Washington University School of Medicine and Health Sciences, Washington, DC; 2The George Washington University, Washington, DC
Introduction: Collagenous gastritis (CG) is a rare inflammatory condition with variable presentation defined by subepithelial deposition of collagen bands in the stomach. We report an atypical case of CG in an adult female presenting with asymptomatic iron deficiency anemia.
Case Description/Methods: A 38-year-old female with iron-deficiency and hypothalamic amenorrhea presented with a one year history of microcytic anemia. She denied gastrointestinal symptoms or bleeding. Hemoglobin was 9.9 grams/deciliter, iron was 23 micrograms/deciliter, iron saturation was 6%, and ferritin was 5 nanograms/milliliter. Comprehensive metabolic panel was normal. Celiac disease panel was negative. Her only medication was a copper intrauterine device. She denied use of nonsteroidal anti-inflammatory drugs, tobacco, alcohol, or drugs. Esophagogastroduodenoscopy revealed diffusely erythematous and nodular gastric mucosa with marked friability. Colonoscopy was normal. Pathology showed collagenous gastritis with severe atrophy (Figure 1). Testing for helicobacter pylori and antiparietal cell and intrinsic factor antibodies were negative. At follow-up, she revealed occasional abdominal cramping, but otherwise remained asymptomatic. She is being treated with omeprazole 40 milligrams daily for six weeks and iron supplementation.
Discussion: CG is rare inflammatory condition of unknown etiology defined histologically by subepithelial deposition of collagen bands ≥ 10 µm in the lamina propria. Adults typically present with diarrhea, often attributed to concurrent collagenous sprue or collagenous colitis, and may have coexisting autoimmune disease. Children more commonly present with abdominal pain and anemia, resulting from bleeding superficial capillaries entrapped in collagen, with inflammation typically limited to the stomach. Endoscopy characteristically reveals nodularity in the gastric body, seen in half of patients. Other findings include erythema, erosions, exudates, or normal mucosa. There are no standard therapies or surveillance recommendations, and long-term sequelae remain unclear. Our patient’s symptoms and endoscopic findings are consistent with previously described pediatric, but not adult, cases of collagenous gastritis, yielding insight into the variable clinical presentation of this rare disease. A recent review found just 60 cases of CG reported from 1989 – 2015, highlighting the importance of further reports to guide clinicians.
Figure: Figure 1: Biopsy from the gastric body shows complete loss of oxyntic glands and deposition of a thick band of collagen under the surface epithelium infiltrated by a few eosinophils. Scale bar = 0.25 millimeters.
Disclosures: Jacyln Kagihara indicated no relevant financial relationships. Julia Boland indicated no relevant financial relationships. Sally Balkovic indicated no relevant financial relationships. Divya Mamilla indicated no relevant financial relationships. Mamoun Younes indicated no relevant financial relationships. Marie Borum indicated no relevant financial relationships. Samuel Schueler indicated no relevant financial relationships.
Jacyln E. Kagihara, MD1, Julia L. Boland, MD1, Sally E. Balkovic, NP-C, DNP1, Divya Mamilla, MD2, Mamoun Younes, MD2, Marie L. Borum, MD, EdD, MPH1, Samuel A. Schueler, MD1. P1045 - Collagenous Gastritis: An Atypical Presentation of a Rare Disease, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.