E0713 - Collagenous Gastritis Treated With Open Capsule Budesonide

Claire Faulkner, BA¹, Aidan J. David, ², Brian M. Fung, MD¹, Lisa Cerilli, MD³, Joseph David, MD^1
1University of Arizona College of Medicine, Phoenix, AZ; ²Case Western Reserve University, Chandler, AZ; ³GI Alliance, Scottsdale, AZ

Introduction: Collagenous gastritis is a rare condition characterized by chronic inflammation and collagen deposition in the gastric mucosa. It remains etiologically elusive, with highly variable clinical outcomes and no recognized therapeutic approach. We present a patient with advanced collagenous gastritis accompanied by collagenous colitis and celiac sprue with a dramatic clinical and histological response to therapy.

Case Description/Methods: A 49-year-old previously healthy female presented with 3 weeks of diarrhea, abdominal cramping, and loss of appetite. Stool studies for common pathogens were negative and a colonoscopy showed normal-appearing mucosa. However, random biopsies contained collagenous colitis; she was thus prescribed bismuth subsalicylate. Due to lack of response, she was subsequently switched to budesonide delayed release capsules, which also failed to improve symptoms. After development of new onset weight loss and depression, an esophagogastroduodenoscopy (EGD) was performed revealing white plaques in the gastric antrum; biopsies revealed marked collagen deposition consistent with collagenous gastritis. In addition, duodenal biopsies incidentally showed villous blunting and intra-epithelial lymphocytosis with a sprue-like pattern. Increased tissue transglutaminase IgA antibody levels (139.6 U/mL) corroborated the impression of celiac sprue. Following 2 months on a gluten-free diet and budesonide, her diarrhea, weight loss, and depression resolved, and she remained asymptomatic 1 year later. To assess mucosal healing, she underwent a repeat EGD and flexible sigmoidoscopy, which showed histological normalization of the duodenal and colonic mucosa. However, persistent collagen deposition was noted in the stomach; she was thus restarted on budesonide with instructions to take the medication sprinkled in apple sauce (open-capsule budesonide). An EGD 3 months later showed interval improvement in the degree of gastric mucosal collagen but persistence of lymphocytic inflammation.

Discussion: Collagenous gastritis is a rare disorder characterized by various patterns of collagen deposition in the gastric wall. Clinical symptoms may include abdominal pain, anemia, diarrhea, nausea and vomiting, and weight loss, among others. A number of therapeutic agents have been utilized but there remains no standardized therapy. This case illustrates clinical and histological improvement in a patient with collagenous gastritis, collagenous colitis, and celiac sprue treated with budesonide administration.


Disclosures:


Claire Faulkner, BA¹, Aidan J. David, ², Brian M. Fung, MD¹, Lisa Cerilli, MD³, Joseph David, MD¹. E0713 - Collagenous Gastritis Treated With Open Capsule Budesonide, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.