Atypical Presentations of Collagenous Gastritis Mimicking Celiac Sprue

Abstract

Collagenous gastritis has been reported as a rare cause of nausea, diarrhea, weight changes, and early satiety in female patients. Here, we describe two women aged 43 and 71 years who presented with similar symptoms. Gastric biopsies from both individuals showed thickened, irregular subepithelial collagen bands (>10 μm). The pathogenesis of collagenous gastritis is poorly understood, but it may be the presenting symptom for many underlying autoimmune conditions. In particular, there is a well-established connection between collagenous disorders of the gastrointestinal tract and celiac sprue, Sjögren syndrome, and lymphocytic colitis; however, none of these conditions had been diagnosed in our patients. The older woman had incidentally discovered hypogammaglobinemia and IgA deficiency, whereas the younger woman suffered from fibromyalgia. Although a gluten-free diet and budesonide have been effective in some cases, there is no standardized therapy for collagenous gastritis. Our patients trialed diet modification and have required no additional medical interventions.

Coexisting Th1 and Th2 cytokines in patients with collagenous gastritis and implications for its pathogenesis

“…Our observation that Th2 cytokines are upregulated in CG suggests potential roles for environmental allergens as triggering or exacerbating factors. Currently, only a handful of studies have evaluated the impact of dietary modification on affected patients, and they have been limited by small patient numbers and minor dietary modifications 5,41–43 . Hypoallergenic diets, including gluten‐free regimens, have proven effective in some individuals with CG but inconsistent overall.…”

“…Currently, only a handful of studies have evaluated the impact of dietary modification on affected patients, and they have been limited by small patient numbers and minor dietary modifications. 5,[41][42][43] Hypoallergenic diets, including gluten-free regimens, have proven effective in some individuals with CG but inconsistent overall. Our findings, in addition to suggesting further investigation of potential links between environmental factors and the development of CG, support the potential therapeutic value of combined anti-inflammatory, antiallergic, and Th2 interleukin receptor modulators such as mepolizumab.…”

Collagenous gastritis: an underdiagnosed cause of abdominal pain

“…Oral budesonide 9 mg/day was started with clinical improvement after two months, pending endoscopic control. 1 2 3 4 5…”