Collagenous gastritis: a morphologic and immunohistochemical study of 40 patients

Abstract

Collagenous gastritis is a rare condition defined histologically by a superficial subepithelial collagen layer. This study further characterizes the morphologic spectrum of collagenous gastritis by evaluating a multiinstitutional series of 40 patients (26 female and 14 male). The median age at onset was 16 years (range 3-89 years), including 24 patients (60%) under age 18. Twelve patients (30%) had associated celiac disease, collagenous sprue, or collagenous colitis. Hematoxylin and eosin slides were reviewed in biopsies from all patients and tenascin, gastrin, eotaxin, and IgG4/IgG immunohistochemical stains were applied to a subset. The distribution of subepithelial collagen favored the body/fundus in pediatric patients and the antrum in adults. There were increased surface intraepithelial lymphocytes (425 lymphocytes/100 epithelial cells) in five patients. Three of these patients had associated celiac and/or collagenous sprue/colitis, while the remaining two had increased duodenal lymphocytosis without specific etiology. An eosinophil-rich pattern (430 eosinophils/high power field) was seen in 21/40 (52%) patients. Seven patients' biopsies demonstrated atrophy of the gastric corpus mucosa. Tenascin immunohistochemistry highlighted the subepithelial collagen in all 21 specimens evaluated and was a more sensitive method of collagen detection in biopsies from two patients with subtle subepithelial collagen. No increased eotaxin expression was identified in 16 specimens evaluated. One of the twenty-three biopsies tested had increased IgG4-positive cells (100/high power field) with an IgG4/IgG ratio of 55%. In summary, collagenous gastritis presents three distinct histologic patterns including a lymphocytic gastritis-like pattern, an eosinophil-rich pattern, and an atrophic pattern. Eotaxin and IgG4 were not elevated enough to implicate these pathways in the pathogenesis. Tenascin immunohistochemistry can be used as a sensitive method of collagen detection.

Diagnosis and treatment of microscopic colitis

“…The overall response may be expected for up to 81 % of MC patients [50]. In contrast, use of mesalazine is less successful to treat MC patients [51]. Other choices may be bismuth salicylate or mesalazine plus cholestylamine, but less possibility of successful treatment is expected, compared to budesonide.…”

“…The disease should receive much greater recognition in order to guide chronic diarrhea patients to the most appropriate diagnosis and treatment. Also, the disease concept is expanding to include analogous diseases not only in the colon, but also in the stomach or small intestine [50,51]. Thus, we should be aware that ''microscopic'' gastrointestinal disease may possibly appear in any part of the gastrointestinal tract.…”

Collagenous gastritis: a case report

“…A recent study7 identified 3 distinct histological patterns of collagenous gastritis: (a) an eosinophil-rich pattern (more than 30 lamina propria eosinophils per high-power field), (b) a lymphocytic gastritis-like pattern (at least 25 intraepithelial lymphocytes per 100 surface epithelial cells) and (c) an atrophic pattern (involves the gastric corpus with marked loss of the oxyntic glands, pyloric metaplasia and minimal ECL cell hyperplasia).12 Clinically, the lymphocytic gastritis-like pattern is believed to be associated with celiac disease, collagenous sprue, and/or collagenous colitis. 7 CG, collagenous colitis and collagenous sprue are thought to be part of the same disease entity -collagenous gastroenteritides. Especially in adult type of CG, it is important to rule out the possible concurrent collagenous sprue or collagenous colitis, which can be done by histological examination of the duodenal biopsies and colon biopsies obtained during esophagogastroduodenoscopy and colonoscopy, respectively.…”

“…7 Collagen analysis has been performed in a few patients with CG and revealed the presence of collagen types III and VI.6,20-23 Type III collagen is released by subepithelial fibroblasts to repair damage caused by inflammation. Therefore, collagen synthesis in CG is probably a reparative response.…”

Lymphocytic gastritis

“…There are reports that LG can associate collagenous gastritis [29,30]. The latter, although, can present a lymphocytic gastritis-like histological pattern [31].…”