COLLAGENOUS GASTRITIS WITH DYSPLASIA

Aims:

Collagenous gastritis (GC) is a rare and idiopathic form of chronic gastritis. The presenting symptoms of the pediatric type are usually abdominal pain and anemia due to digestive bleeding. On endoscopy, nodular mucosa changes are seen in the stomach. In adults, the main clinical symtom is diarrhea due to its greater association with collagenous colitis.

Methods:

A 44-year-old Caucasian man presented with epigastric pain and minor weight loss. A gastroscopy showed gastric mucosa nodulations in the body-antrum. (Figure 1). The consistency and distensibility of the gastric wall was normal.

Results:

Gastric biopsies revealed subepithelial collagen deposits and inflamatory infiltration of the lamina propria (Figure 2). Foci of low-grade dysplasia (LGD) of the epithelium had also seen. The test for Helicobacter pylori was negative. Duodenal biopsies, abdominal-CT, colonoscopy with biopsies, antiparietal cell antibodies, anti-intrinsic factor antibodies, antitransglutaminasa/antigliadin antibodies and tumor markers, were normal. Vitamin B12 level was low. Treatment with PPI, prokinetic agents and vitamin B12 was initiated. Follow-up: gastroscopy 6 months later without morphological/histological changes. Slight clinical improvement, maintains weight and has appetite.

Conclusions:

GC is an infrequent entity, with different forms of presentation. A standard treatment has not yet been established. Its course and prognosis is uncertain. No associated cases of carcinoma/lymphoma have been described. This entity requires periodic reviews. In our case, with LGD, they will be performed every 6 – 12 months.