Proximal collagenous gastroenteritides: clinical management. A systematic review.
OBJECTIVE
While collagenous colitis represents the most common form of the collagenous gastroenteritides, the collagenous entities affecting the proximal part of the gastrointestinal tract are much less recognized and possibly overlooked. The aim was to summarize the latest information through a systematic review of collagenous gastritis, collagenous sprue, and a combination thereof.


METHODS
The search yielded 117 studies which were suitable for inclusion in the systematic review. Excluding repeated cases, 89 case reports and 28 case series were reported, whereas no prospective studies with or without control groups were identified. Further, no randomized, controlled trials were identified. The total number of patients with proximal collagenous gastroenteritides reported was 330.


RESULTS
An overview of clinical presentations, prognosis, pathophysiology and histopathology, as well as management of these disorders is presented. The prognosis of both collagenous gastritis and sprue seems not to be as dismal as considered previously. Data point to involvement of immune or autoimmune mechanisms potentially driven by luminal antigens initiating the fibroinflammatory condition.


CONCLUSIONS
To reach the diagnosis it is recommended that biopsies are obtained during gastroduodenoscopies. Therapies with anti-secretory strategies, glucocorticoids, and in some cases iron supplementation are suggested, although rational treatment options from randomized, controlled trials do not exist for these rare or even overlooked disorders.
Department of Gastroenterology, Medical Section, Herlev Hospital, University of Copenhagen , Denmark.
Ole Haagen
OH
Nielsen
Lene Buhl
LB
Riis
Silvio
S
Danese
Rasmus Dahlin
RD
Bojesen
Christoffer
C
Soendergaard
D001706:Biopsy; D046729:Colitis, Collagenous / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D003094:Collagen / Q000378:metabolism; D064068:Collagenous Sprue / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005756:Gastritis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D005759:Gastroenteritis / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D058085:Iron Compounds / Q000627:therapeutic use; D011379:Prognosis
D005938:Glucocorticoids; D058085:Iron Compounds; D003094:Collagen
Collagenous duodenitis; collagenous gastritis; collagenous sprue; diagnosis; histology; therapy