Outcomes of Collagenous Gastritis

BC Beinvogl et al. JPGN 2021; 73: 513-519. Pediatric Collagenous Gastritis: Clinical and Histologic Outcomes in a Large Pediatric Cohort

In this retrospective single-center cohort study with 40 patients (1992-2020), the authors describe the outcomes and heterogeneity of treatments for pedicatric collagenous gastritis (CG). The mean age at diagnosis was 11 years with mean followup of 2.9 years.

Key points:

  • Presenting symptoms: abdominal pain, vomiting, symptomatic anemia, and nausea. 25 of 40 had a colonoscopy at time of index EGD
  • 75% had iron-deficiency anemia which responded well to iron supplementation
  • Comorbid conditions included autoimmune disorders in 12.5% and immunodeficiencies in 5%. 7 (17.5%) had excess collagen in duodenum, 3 (7.5%) had collagenous colitis, and 1 (2. 5%)had collagenous ileitis.
  • 85% of diagnosis were made on initial review of biopsy slides; other cases were identified subsequently either due to repeat endoscopy or further slide review. CG is “known to be patchy
  • No treatments were clearly effective in improving histology. Treatments included PPI/H2RAs in 40%, laxatives in 20%, cyproheptadine in 12.5%, antiemetics in 12.5%, cafafate in 7.5%, budesonide in 7.5% and others less frequently
  • 92% had persistent abnormal endoscopic findings and 73% had persistent thickened subepithelial collagen. In those without excess collagen deposition at last EGD, some of this could be related to patchy distribution as well as improvement
  • Though histology often did not improve, 87.5% had improvement or resolution of symptoms
  • Long-term outcomes remain unknown. While there is concern for possible malignant transformation, to date “no gastric epithelial or lymphoid malignancies have been…reported”

My take: Collagenous gastritis is poorly understood. Fortunately, most patients symptoms resolve/improve.

Related blog post: Collagenous gastritis (2020) -useful reference