A Truth Unraveled: Unpredictable Collagenous Gastritis Explains Vague Upper Abdominal Symptoms

Abstract

Collagenous gastritis (CG) is a rare disease characterized by subepithelial deposition of collagen bands and inflammatory cell infiltrates in the lamina propria. Owing to the rare occurrence, little is known about its clinical manifestations which are both diverse and nonspecific. Furthermore, the pathogenesis of CG remains unclear although there are reported associations with autoimmune conditions including celiac disease and type I diabetes. Currently, there is no effective treatment for this disease. A 64-year-old female with a history of gastroesophageal reflux disease and hypothyroidism presented to the clinic for evaluation of nausea, bilious emesis, early satiety, and an unintentional weight loss of 10 pounds within the past few months. There were no alleviating or aggravating factors and she denied any changes in her bowel function or a familial history of colon cancer. Physical exam demonstrated left lower quadrant fullness. A stool-DNA screening test was negative. Esophagogastroduodenoscopy (EGD) demonstrated a diffusely nodular and congested appearance mainly in the antrum without bleeding, consistent with gastritis. Biopsies were obtained which revealed collagenous gastritis but negative immunoperoxidase staining for lymphoma, Congo red stain for amyloid, and immunohistochemical staining for Helicobacter pylori. A repeat EGD with biopsy demonstrated patchy, mild villous blunting with very few intraepithelial lymphocytes. Antibodies could not be obtained as the patient was lost to follow-up. Patients often present to the clinic with vague gastrointestinal symptoms that warrant endoscopic evaluation. In this case report, we were able to demonstrate the findings of collagenous gastritis, a rare condition that has been reported less than 300 times at the time of this report. This particular case highlights the importance of obtaining the histopathology as it may allow clinicians to rule out reversible causes that may be amenable to treatment prior to making a diagnosis of an untreatable condition such as CG. Furthermore, the second biopsy of our patient suggests that this disease may be linked to celiac disease which is consistent with other reports that suggest CG being related to other autoimmune conditions. Thus, it is of vital importance to create a wider recognition of this condition’s histopathologic features and to examine its clinical associations in order to standardize a more effective therapy for this untreatable disease.