P3385 - Collagenous Gastritis in a Young Adult: Diagnostic Challenges and Therapeutic Approaches

Fariha Hasan, MD¹, Rimmel Ali, MBBS², Kim HooKim, MD³, Krysta Contino, MD^4
1Cooper University Hospital, Philadelphia, PA; ²Dow Medical College, Karachi, Sindh, Pakistan; ³Cooper University Hospital, Camden, NJ; ⁴Digestive Health Institute at Cooper University Hospital, Mount Laurel, NJ

Introduction: Collagenous gastritis (CG) is a rare condition, often characterized by non-specific symptoms such as abdominal pain, nausea, vomiting, and diarrhea. Accurate diagnosis relies heavily on endoscopic examination and histological analyses, given its association with collagenous colitis and celiac disease. The limited number of reported cases underscores the need for a comprehensive understanding of CG for effective management and patient care.

Case Description/Methods: A 25-year-old female with a history of peptic ulcer disease (PUD), treated eosinophilic gastritis, and iron deficiency anemia presented with nausea and chronic epigastric pain, unresponsive to proton pump inhibitors (PPIs). She reported a prior hospital admission for three episodes of coffee-ground emesis, with a hemoglobin level of 9 g/dL. Physical examination revealed epigastric tenderness. An esophagogastroduodenoscopy (EGD) performed after the bleeding episode showed chronic active gastritis with eosinophilia but no active source of bleeding and negative H. pylori. Three months later, a repeat EGD revealed significantly nodular gastric mucosa. Biopsies indicated mild to moderate chronic gastritis with increased subepithelial collagenous fibrosis. Trichrome staining confirmed collagenous gastritis, showing increased subepithelial fibrosis without significant eosinophils. The patient remains on twice daily proton pump inhibitor therapy with discussions about transition to budesonide therapy.

Discussion: This case involves a young female patient presenting with chronic epigastric pain and vomiting as primary symptoms, without weight loss or diarrhea. Coffee-ground emesis, an uncommon finding in CG, was also observed. Pathological findings indicated inflammation limited to the stomach, consistent with the child-adolescent type of CG. The patient's medical history of peptic ulcer disease and eosinophilic gastritis complicated the diagnosis.

Treatment typically involves PPIs, H2 receptor antagonists, and iron and aluminum supplementation. Budesonide has also been presented as a potential treatment, although given the lack of standard protocol, the risks and benefits of treatments must be discussed with patients and selected on a case-by-case basis. The therapeutic decision includes consideration of current evidence and clinical trial data to address the patient's symptoms and improve outcomes.



Disclosures:


Fariha Hasan, MD¹, Rimmel Ali, MBBS², Kim HooKim, MD³, Krysta Contino, MD⁴. P3385 - Collagenous Gastritis in a Young Adult: Diagnostic Challenges and Therapeutic Approaches, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.