Collagenous gastritis is a rare inflammatory condition that affects the stomach lining. It is characterized by a thick band of collagen, typically exceeding 10 micrometers, deposited beneath the stomach’s surface lining. It is uncommon, with few cases reported globally since its first identification in 1989. Collagenous gastritis is not contagious and cannot be transmitted from person to person.
Associated Symptoms and Conditions
Individuals with collagenous gastritis frequently experience a range of gastrointestinal symptoms, which vary by age and disease extent. Children often present with severe, chronic abdominal pain and iron deficiency anemia. Adults, in contrast, often report chronic diarrhea and unintended weight loss. Other symptoms include persistent nausea, recurrent vomiting, and a feeling of early fullness after eating.
Iron deficiency anemia, characterized by low red blood cell counts, is a frequent finding. It often results from impaired iron absorption or subtle blood loss from the gastric lining. Collagenous gastritis also shows a strong association with other similar conditions, such as collagenous colitis, which involves similar collagen deposition in the colon and often presents with chronic diarrhea. It is also linked to celiac disease, lymphocytic gastritis, and other systemic autoimmune disorders like Sjögren syndrome.
Causes and Risk Factors
The precise cause of collagenous gastritis remains largely unknown, classifying it as an idiopathic condition. The leading theory suggests an autoimmune process, where the immune system mistakenly attacks healthy gastric lining cells. This immune response triggers chronic inflammation within the stomach, driving excessive collagen deposition beneath the stomach’s surface.
The frequent co-occurrence with other autoimmune diseases, such as celiac disease and lymphocytic colitis, supports this autoimmune hypothesis, suggesting a shared predisposition. It affects all age groups, with a bimodal age distribution: more commonly diagnosed in children and young adults (often with abdominal pain), but also recognized in older adults.
The Diagnostic Process
Diagnosing collagenous gastritis cannot rely solely on clinical symptoms, as these signs often overlap with many other common gastrointestinal disorders, making definitive diagnosis challenging. Definitive diagnosis primarily involves an upper endoscopy, where a camera-equipped tube visualizes the esophagus, stomach, and duodenum. During endoscopy, the gastric lining may appear inflamed (erythematous) and sometimes nodular, particularly in the antrum and pylorus regions. However, these findings are not exclusive to collagenous gastritis.
A biopsy is taken from the stomach lining during endoscopy for microscopic examination. A pathologist analyzes this tissue sample to identify the hallmark sign: an abnormally thick subepithelial collagen band (exceeding 10 micrometers) and an infiltration of inflammatory mononuclear cells in the lamina propria. Blood tests are also performed to assess for iron deficiency anemia and to screen for specific antibodies associated with celiac disease, such as tissue transglutaminase antibodies.
Management and Treatment Approaches
There is no single cure for collagenous gastritis; treatment focuses on managing inflammation and alleviating symptoms. Medications include proton pump inhibitors (PPIs), which reduce stomach acid production and help relieve symptoms like epigastric pain and nausea. Corticosteroids, such as oral prednisone or locally acting budesonide, are often prescribed to suppress gastric inflammation and reduce the immune response. Topical budesonide, delivered via open capsules or compounded formulations, has shown significant clinical and histological responses, often proving effective even when other therapies fail.
Dietary interventions are also considered, particularly when concurrent conditions are identified. If celiac disease is diagnosed, strict adherence to a gluten-free diet is an important part of the management plan. Supportive care is also provided to address specific deficiencies; for instance, iron supplementation treats iron deficiency anemia.
Long-Term Outlook
Collagenous gastritis is generally considered a chronic condition, meaning it typically persists and requires ongoing medical management. The disease course can be variable; some patients may achieve long-term remission, with symptoms significantly improving or disappearing with consistent treatment. Others might experience symptom relapse followed by remission, indicating fluctuating disease activity that necessitates continuous monitoring.
The primary objective of long-term management is to control symptoms, prevent complications such as severe anemia or malabsorption, and maintain quality of life. Consistent medical care, including regular follow-up appointments with gastroenterologists and diligent adherence to prescribed treatments, plays a substantial role in effectively managing the condition long-term and optimizing patient outcomes.