A0228 - Incredibly Unique Case of Collagenous Esophagitis in a Long Segment Barret’s Esophagus: Complication of Chronic Reflux or a New Entity?

Albina Joldoshova, MD¹, Celia Marginean, MD², Nabil Mansour, MD², Deyali Chatterjee, MD², Shilpa Jain, MD^2
1Baylor College of Medicine, Sugar Land, TX; ²Baylor College of Medicine, Houston, TX

Introduction: Collagenous gastroenteritides including collagenous gastritis, collagenous sprue, and collagenous colitis, are all uncommon entities. Esophageal lamina propria fibrosis has been established in eosinophilic esophagitis as a long-term consequence of remodeling. The esophageal subepithelial collagen deposits can be regarded as collagenous esophagitis which is a new entity. We herein report a case of concurrent collagenous carditis and collagenous esophagitis in a patient with Barrett’s esophagus (BE).

Case Description/Methods: 36-yo male with complex medical history of cerebral palsy, seizure disorder, hypothyroidism, chronic gastroesophageal reflux disease, and erosive esophagitis developed benign esophageal intrinsic stenosis at 23 cm from the incisors and BE in the lower third of the esophagus within ten-year period, which necessitated two endoscopic balloon dilatation procedures. Of note, he did not receive radiofrequency ablation or mucosal resection therapies at any point of time.
Subsequent three endoscopies and esophageal and cardiac biopsies away from the stricture (between 25-33 cm from the incisors) demonstrated BE indefinite for dysplasia. The most recent one in addition to intestinal metaplasia had a new finding of lamina propria fibrosis with diffuse band-like subepithelial collagen deposits more than 10 µm in thickness, confirmed by Trichrome stains. Congo red stains were negative. Features of eosinophilic esophagitis were absent. These findings were compatible with collagenous esophagitis and collagenous carditis diagnosis (Figure).

Discussion: Collagenous gastritis is an extremely rare and poorly understood process with female and young adult predominance. The adult-onset collagenous gastritis is antrum dominant and is associated with collagenous colitis and autoimmune disorders, such as celiac disease, thyroid disorder, and others. Our patient had collagenous carditis with collagenous esophagitis in the background of BE, which has never been described before.



Disclosures:


Albina Joldoshova, MD¹, Celia Marginean, MD², Nabil Mansour, MD², Deyali Chatterjee, MD², Shilpa Jain, MD². A0228 - Incredibly Unique Case of Collagenous Esophagitis in a Long Segment Barret’s Esophagus: Complication of Chronic Reflux or a New Entity?, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.