Stomach
Gastritis
Collagenous gastritis
Authors: Matthew Morrow, M.D., Raul S. Gonzalez, M.D.
Editor-in-Chief: Debra L. Zynger, M.D.
Last author update: 12 January 2021
Last staff update: 27 July 2023
Copyright: 2002-2024, PathologyOutlines.com, Inc.
PubMed Search: Collagenous gastritis
Table of Contents
Definition / general | Essential features | ICD coding | Epidemiology | Sites | Pathophysiology | Clinical features | Diagnosis | Case reports | Treatment | Clinical images | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Sample pathology report | Differential diagnosis | Additional references | Board review style question #1 | Board review style answer #1 | Board review style question #2 | Board review style answer #2Cite this page: Morrow M, Gonzalez RS. Collagenous gastritis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/stomachcollagenous.html. Accessed April 25th, 2024.
Definition / general
- Poorly understood disease manifesting as thickened subepithelial collagen in the stomach
Essential features
- An extremely rare disease characterized by the presence of a band of increased subepithelial collagen in the stomach, with associated chronic inflammation in the lamina propria
- Often subtyped into pediatric and adult versions
- No standard therapy
ICD coding
- ICD-10: K52.89 - Other specified noninfective gastroenteritis and colitis
Epidemiology
- Extremely rare, with only 60 cases reported since it was first described in 1989 (World J Gastrointest Endosc 2015;7:265)
- Slight female predominance, occurring in all ages, but age at presentation centers around young adults (J Nat Sci Biol Med 2018;9:285)
Sites
- Pediatric patients possibly more likely to have body / fundus predominant disease versus antrum in adults (Mod Pathol 2015;28:533)
Pathophysiology
- Poorly understood etiology / pathophysiology
Clinical features
- Associated with celiac disease, collagenous colitis, collagenous sprue and other autoimmune disease (Arch Pathol Lab Med 2001;125:1579)
- Most common clinical symptoms include abdominal pain, anemia, diarrhea, nausea / vomiting, GI bleeding and weight loss
- Through limited case reports, the disease has been phenotyped into adult and pediatric types but many patients may not fit either category (Am J Surg Pathol 2001;25:1174)
- Pediatric type classically presents with upper GI symptoms including abdominal pain and anemia, which are a result of the disease process
- Adult type is characterized by accompanying collagenous colitis, related to underlying autoimmune processes or celiac disease
Diagnosis
- Established by gastric biopsy
Case reports
- 12 year old girl with abdominal pain and low ferritin (Rev Esp Enferm Dig 2015;107:313)
- 21 year old woman with gastritis after Helicobacter pylori eradication (ACG Case Rep J 2017;4:e69)
- 26 year old woman with a past medical history of gastroesophageal reflux disease and scleroderma presenting with abdominal pain and diarrhea (Gastroenterology Res 2017;10:126)
- 47 year old woman with systemic lupus erythromatosis presenting with mild anemia and dyspepsia (J Med Case Rep 2014;8:278)
Treatment
- No standard therapy has been defined
Clinical images
Contributed by Matthew Morrow, M.D.
Gastric nodularity
Gastric mucosa with mild nodularity
Images hosted on other servers:
Nodular gastric mucosa
Gross description
- Nodularity of the gastric corpus is the characteristic endoscopic finding but is not seen in all cases (World J Gastrointest Endosc 2015;7:265)
- Depressed mucosa between the nodules shows atrophy and deposition of subepithelial collagen, whereas the nodular lesions themselves show unaffected mucosa (Dig Dis Sci 2007;52:995)
- Other mucosal findings include erythema, erosions and exudate
- Occasionally there are no findings (akin to collagenous colitis)
Microscopic (histologic) description
- Patchy increased subepithelial collagen, having a thickness ≥ 10 µm
- Maximum thickness on average ranges from 15 to 115 μm, mean 55.1 μm (Mod Pathol 2015;28:533)
- Often associated with the entrapment of red blood cells, inflammatory cells and superficial capillaries (Am J Surg Pathol 2001;25:1174)
- Associated with the denudation or separation of the surface gastric epithelium
- Increased chronic inflammatory infiltrate of the lamina propria including increased eosinophils and many times neutrophils
- Increased intraepithelial lymphocytes, but fewer than in lymphocytic gastritis
- Histologic features may persist for years (Mod Pathol 2015;28:533)
Microscopic (histologic) images
Contributed by Matthew Morrow, M.D.
Increased subepithelial collagen with lamina propria chronic inflammation
Denudation of surface gastric epithelium
Thickened subepithelial collagen
Collagenous gastritis 100x
Abundant eosinophils 40x
Images hosted on other servers:
Thickened subepithelial collagen
Lamina propria inflammation
Positive stains
- Masson trichrome stain highlights the thickened subepithelial layer of collagen
Negative stains
Sample pathology report
- Stomach, antrum, biopsy:
- Collagenous gastritis (see comment)
- Comment: A trichrome special stain highlights a thickened basement membrane.
Differential diagnosis
- Amyloid deposition:
- Positive for Congo red
- Autoimmune gastritis or radiation therapy effect:
- May show diffuse collagen deposition, not specifically located in a subepithelial location
- Scleroderma:
- Fibrosis at all levels of the mucosa and possibly also deep to the mucosa (Ital J Anat Embryol 2010;115:115)
- Tangential sectioning of normal subepithelial collagen:
- Other features (e.g. increased inflammation) not seen
- May need to correlate with clinical presentation
Additional references
Board review style question #1
- A 10 year old boy presents with chronic abdominal pain and anemia. The following is a biopsy from the stomach. Which of the following statements is true?
- Immunosuppression is standard therapy
- The absence of both HLA-DQ2 and HLA-DQ8 haplotypes essentially excludes the diagnosis
- The histologic features may persist for years
- The pediatric type of the disease is classically characterized by accompanying collagenous colitis
Board review style answer #1
C. The histologic features may persist for years. In one study, of the patients who had follow up biopsies, 75% had persistent histologic features, sometimes lasting up to 10 years (Mod Pathol 2015;28:533).
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Reference: Collagenous gastritis
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Reference: Collagenous gastritis
Board review style question #2
- Which of the following statements about collagenous gastritis is true?
- An increase in collagen is seen in the deep lamina propria and bowel wall
- If nodular gastric mucosa is seen, for diagnosis of this entity it is best to biopsy at the tips of the nodules
- It can be associated with celiac disease
- It is mainly a disease of the elderly
Board review style answer #2
C. Collagenous gastritis can be associated with celiac disease
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Reference: Collagenous gastritis
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Reference: Collagenous gastritis
