Katlin Wilson, MS, Areeba Rizvi, MD, Kevin Turner, DO University of Minnesota, Minneapolis, MN
Introduction: Collagenous Gastritis (CG) is a rare type of gastritis characterized by thickened subepithelial collagen and a chronic inflammatory infiltrate. While CG has been well-documented within the pediatric population, it is classically limited to the stomach unlike the adult type which is not infrequently seen with concurrent collagenous changes in the small intestine and colon. We report a unique presentation of a 13 year old previously healthy female with collagenous sprue, collagenous gastritis and chronic atrophic gastritis.
Case Description/Methods: The patient, with a positive family history for autoimmune disease(s), presented for a wellness checkup with severe fatigue and exertional dyspnea. Further investigation revealed profound iron deficiency anemia which resulted in referral to the emergency department for transfusion and a detailed work up. Her TTG IgA was normal and fecal calprotectin was elevated. An EGD was performed revealing nodular gastric body mucosa and diffuse flattening of the duodenal mucosa. Her colonoscopy was unremarkable. The gastric biopsies showed severe chronic inactive gastritis with focal activity, intraepithelial lymphocytosis, thickened subepithelial collagen (Figure 1), in addition to partial oxyntic glandular atrophy and linear endocrine cell hyperplasia. Helicobacter immunohistochemical stain performed on gastric biopsy was negative. Duodenal biopsies showed villous atrophy, crypt hyperplasia, intraepithelial lymphocytosis, lymphoplasmacytic expansion of the lamina propria, and thickened subepithelial collagen consistent with collagenous sprue.
Discussion: The simultaneous presentation of collagenous sprue, CG and chronic atrophic gastritis is an uncommon presentation in children. Elucidation of the underlying pathogenesis is imperative for improved management.
Figure: Figure 1: A) 20X H&E Duodenum, B) 20X Trichrome Duodenum, C) 20X H&E Gastric Body, D) 20X Trichrome Gastric Body
Disclosures:
Katlin Wilson indicated no relevant financial relationships.
Areeba Rizvi indicated no relevant financial relationships.
Kevin Turner indicated no relevant financial relationships.
Katlin Wilson, MS, Areeba Rizvi, MD, Kevin Turner, DO. P1624 - Collagenous Gastroduodenitis in a Pediatric Patient, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
