P1701 - Collagenous Gastritis: A Rare Cause of Hemorrhagic Shock

Brenton Davis, MD, Max Goldman, MD, Angela Lam, MD, Jeffrey Fox, MD
Kaiser Permanente, San Francisco, CA

Introduction: Collagenous gastritis (CG) is a rare chronic condition compromised of two phenotypes – pediatric onset and adult onset. Pediatric onset CG is associated with iron deficiency anemia (IDA), abdominal pain, and upper gastrointestinal bleeding (GIB). In contrast, adult onset CG is often related to collagenous colitis or medications. Diagnosis requires histologic evidence of subepithelial collagen deposition in bands thicker than 10µm with inflammatory infiltrate in the lamina propria. Of the cases described, treatment usually involves oral iron, proton pump inhibitors, and close follow-up with topical budesonide therapy showing histologic improvement in patients. We describe a case of budesonide refractory CG causing hemorrhagic shock and use of vedolizumab as therapy.

Case Description/Methods: A 16-year-old boy with history of abdominal pain, prior endoscopy and persistent IDA despite oral supplementation for 1 year presented to the emergency department with syncope, severe anemia with a hemoglobin of 6mg/dL and hemorrhagic shock. On initial endoscopy for IDA, nodular gastric mucosa with cherry reds spots were noted. Biopsies showed chronic active inflammation with eosinophilia. His full blood count was normal, and colonoscopy was negative. On his inpatient endoscopy, diffuse nodularity with adjacent linear depressions and a gastric ulcer were noted with biopsies taken. Histology showed subepithelial collagen deposition thicker than 10µm with trapping of lamina propria elements. On repeat endoscopy 3 months after PPI, iron and oral budesonide therapy, gastric nodularity with serpiginous depressions and thickened mucosa were noted. Four months later despite therapy he had a second GIB requiring endoscopic therapy. Repeat biopsy showed histologic improvement. Given his clinical worsening, after multidisciplinary discussion, he underwent prophylactic left gastric, short gastric, and gastroepiploic artery embolization. He then transitioned from budesonide to vedolizumab with plan for repeat endoscopy in 6 months for reassessment.

Discussion: CG is a rare chronic disease with pediatric onset and adult onset phenotypes. This case demonstrates CG can range in severity of disease and endoscopic appearance depending on when during the disease course endoscopy is performed. As in our patient, vedolizumab is also starting to show utility as another agent that has potential to help treat this emerging entity.



Disclosures:


Brenton Davis, MD, Max Goldman, MD, Angela Lam, MD, Jeffrey Fox, MD. P1701 - Collagenous Gastritis: A Rare Cause of Hemorrhagic Shock, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.