title: Clinical outcome of pediatric collagenous gastritis: case series and review of literature.
abstract: Collagenous gastritis (CG) is characterized by patchy subepithelial collagen bands. Effective treatment and the clinical and histological outcome of CG in children are poorly defined. The aim of this study is to summarize the published literature on the clinical outcome and response to therapy of pediatric CG including two new cases. We performed a search in Pubmed, OVID for related terms; articles including management and clinical and/or endo-histologic follow up information were included and abstracted. Reported findings were pooled in a dedicated database including the corresponding data extracted from chart review in our patients with CG. Twenty-four patients were included (17 females) with a mean age of 11.7 years. The clinical presentation included iron deficiency anemia and dyspepsia. The reported duration of follow up (in 18 patients) ranged between 0.2-14 years. Despite most subjects presenting with anemia including one requiring blood transfusion, oral iron therapy was only documented in 12 patients. Other treatment modalities were antisecretory measures in 13 patients; proton pump inhibitors (12), or histamine-2 blockers (3), sucralfate (5), prednisolone (6), oral budesonide in 3 patients where one received it in fish oil and triple therapy (3). Three (13%) patients showed no clinical improvement despite therapy; conversely 19 out of 22 were reported with improved symptoms including 8 with complete symptom resolution. Spontaneous clinical resolution without antisecretory, anti-inflammatory or gastroprotective agents was noted in 5 patients (4 received only supplemental iron). Follow up endo-histopathologic data (17 patients) included persistent collagen band and stable Mononuclear cell infiltrate in 12 patients with histopathologic improvement in 5 patients. Neither collagen band thickness nor mononuclear cell infiltrate correlated with clinical course. Intestinal metaplasia and endocrine cell hyperplasia were reported (1) raising the concern of long term malignant transformation. In summary, CG in children is a chronic disease, typically with a variable clinical response and an indolent course that is distinct from the adult phenotype. Long term therapy usually included iron supplementation but cannot be standardized, given the chronicity of the disease, variability of response and potential for adverse events.
authors.affiliation: Section of Pediatric Gastroenterology, Children's Mercy Hospital, Kansas, MO 64108, USA. nmhijaz@cmh.edu
authors.forename: Nadia Mazen
authors.initials: NM
authors.lastname: Hijaz
authors.forename: Seth Steven
authors.initials: SS
authors.lastname: Septer
authors.forename: James
authors.initials: J
authors.lastname: Degaetano
authors.forename: Thomas Mario
authors.initials: TM
authors.lastname: Attard
mesh_terms: D000293:Adolescent; D000367:Age Factors; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy / Q000209:etiology; D001706:Biopsy; D002648:Child; D002908:Chronic Disease; D003094:Collagen / Q000378:metabolism*; D004359:Drug Therapy, Combination; D004415:Dyspepsia / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005753:Gastric Mucosa / Q000378:metabolism; D005756:Gastritis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D007223:Infant; D008297:Male; D010641:Phenotype; D011237:Predictive Value of Tests; D013270:Stomach / Q000187:drug effects* / Q000473:pathology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003094:Collagen
keywords: Collagenous colitis; Collagenous gastritis; Gastritis; Lymphocytic gastritis; Pediatric
references.citation: Cases J. 2009 Jun 10;2:7511
references.pmid: 19829984
references.citation: Endoscopy. 2007 Feb;39 Suppl 1:E292-3
references.pmid: 17957644
references.citation: Eur J Gastroenterol Hepatol. 2009 Dec;21(12):1419-24
references.pmid: 19730387
references.citation: Dig Dis Sci. 2007 Apr;52(4):995-1000
references.pmid: 17342397
references.citation: Gastroenterology. 1989 Dec;97(6):1552-5
references.pmid: 2583419
references.citation: Arch Pediatr. 2001 Jan;8(1):47-50
references.pmid: 11218583
references.citation: J Pediatr Gastroenterol Nutr. 2007 Nov;45(5):603-6
references.pmid: 18030241
references.citation: Am J Clin Pathol. 2001 Nov;116(5):753-8
references.pmid: 11710694
references.citation: Endoscopy. 2009;41 Suppl 2:E233-4
references.pmid: 19757370
references.citation: Am J Surg Pathol. 2001 Sep;25(9):1174-9
references.pmid: 11688577
references.citation: Hum Pathol. 1998 Aug;29(8):883-6
references.pmid: 9712433
references.citation: Mod Pathol. 2000 May;13(5):591-6
references.pmid: 10824933
references.citation: Am J Surg Pathol. 2009 May;33(5):788-98
references.pmid: 19295410
references.citation: Scand J Gastroenterol. 1999 Jun;34(6):632-8
references.pmid: 10440616
references.citation: Gastroenterology. 2008 Jul;135(1):17, 327
references.pmid: 18555018
references.citation: Ann Rheum Dis. 2009 Dec;68(12):1833-8
references.pmid: 19066177
references.citation: Curr Gastroenterol Rep. 2010 Dec;12(6):448-57
references.pmid: 20882439
references.citation: Acta Gastroenterol Belg. 2011 Sep;74(3):468-74
references.pmid: 22103057
references.citation: J Pediatr Gastroenterol Nutr. 2009 Aug;49(2):157
references.pmid: 19561541
references.citation: Eur J Pediatr. 2007 Aug;166(8):769-73
references.pmid: 17453238
references.citation: J Korean Med Sci. 2005 Feb;20(1):146-9
references.pmid: 15716621