Background

This rare form of gastritis is related to collagenous colitis with subepithelial thickening of the basement membrane 20-30 times the normal mucosa (greater than 10 microns). The majority of cases are associated with collagenous or lymphocytic colitis. The majority are women and present with a watery diarrhea.

Besides the thickened subepithelial basement membrane, there are lymphocytic infiltrates distributed within the mucosa producing a chronic or chronic active gastritis the most common accompaniment.

OUTLINE

Epidemiology
Disease Associations
Pathogenesis
Laboratory/Radiologic/Other Diagnostic Testing
Gross Appearance and Clinical Variants
Histopathological Features and Variants
Special Stains/Immunohistochemistry/Electron Microscopy
Differential Diagnosis
Prognosis
Treatment
Commonly Used Terms
Internet Links

DISEASE ASSOCIATIONS	CHARACTERIZATION
Collagenous gastritis associated with lymphocytic colitis. Groisman GM, Meyers S, Harpaz N. Department of Pathology, Mount Sinai School of Medicine of the City University of New York, New York, USA.	J Clin Gastroenterol 1996 Mar;22(2):134-7 Abstract quote Collagenous sprue and collagenous colitis are two well-recognized idiopathic enteritides whose defining histologic attribute is fibrous thickening of the subepithelial basement membrane. Analogous changes in gastric mucosa seem to be quite rare. The term "collagenous gastritis" was recently applied for the first time to an isolated case of refractory gastritis in which distinctive subepithelial gastric fibrosis was noted. We report an additional case of this entity in a 35-year-old woman with refractory dyspepsia. In contrast to the earlier case of collagenous gastritis, our patient also had lymphocytic colitis, a type of colitis associated with watery diarrhea. C ollagenous gastritis appears to be a distinct clinicopathologic entity, the histologic changes of which should be sought in patients with unexplained dyspepsia. Increased awareness of this condition and its possible clinical correlates may provide clues to its etiology and pathogenesis.
GROSS OR CLINICAL VARIANTS	CHARACTERIZATION
WEIGHT LOSS
Collagenous gastritis: an unusual association with profound weight loss. Wang HL, Shah AG, Yerian LM, Cohen RD, Hart J. Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University School of Medicine, St Louis, Mo 63110-1093, USA.	Arch Pathol Lab Med. 2004 Feb;128(2):229-32. Abstract quote   Collagenous gastritis is a distinctive disorder characterized by thickening of the subepithelial collagen layer in the gastric mucosa. Although this entity was recognized in 1989, its etiology, pathogenesis, and clinicopathologic features remain poorly understood because of its rarity. An unusual case of collagenous gastritis was observed in a 37-year-old man who presented with profound weight loss, a feature that has not previously been emphasized.

 

HISTOLOGICAL TYPES	CHARACTERIZATION
General
Collagenous gastrobulbitis and collagenous colitis. Case report and review of the literature. Castellano VM, Munoz MT, Colina F, Nevado M, Casis B, Solis-Herruzo JA. Dept. of Pathology, 12 de Octubre Hospital, Madrid, Spain.	Scand J Gastroenterol 1999 Jun;34(6):632-8 Abstract quote A case is reported of collagenous gastrobulbitis on collagenous colitis in a 57-year-old woman with a 6-month history of watery diarrhea. Low serum levels of total proteins and albumin and increased fecal elimination of alpha1-antitrypsin were the only abnormal laboratory test results. Biopsy specimens from the colon, rectum, antrum, fundus, and duodenal bulb showed a thick subepithelial band composed of ultrastructurally normal collagen immunohistochemically negative for collagen IV and laminin. The diarrhea resolved with prednisone and responded to this treatment after a relapse 6 months later. One year later the patient developed severe alimentary intolerance and secondary weight loss. This symptom also responded to the same treatment. However, the collagen deposition did not disappear in the second biopsy samples of colonic and gastric mucosa. Only six cases have been previously reported with gastric and/or duodenal subepithelial collagenous deposition. Four were associated with collagenous colitis. One of these presented a subepithelial collagenous band in the terminal ileum. All these features suggest that this collagen deposition may affect the entire digestive tract with variable intensity, extension, and symptoms.
Collagenous gastritis: a case report, morphologic evaluation, and review. Vesoulis Z, Lozanski G, Ravichandran P, Esber E. Department of Pathology, Summa Health Systems, Akron, Ohio 44304, USA.	Mod Pathol 2000 May;13(5):591-6 Abstract quote Collagenous gastritis is rare; there are only four previous case reports. Histologic features seem to overlap with the other "collagenous enterocolitides"; however, pathologic criteria are not yet established for the diagnosis of collagenous gastritis. We describe an additional case of ostensible collagenous gastritis in a patient who initially presented with celiac sprue and subsequently developed colonic manifestations of mucosal ulcerative colitis. Endoscopic biopsies of the stomach revealed deposition of patchy, very thick bandlike subepithelial collagen in gastric antral mucosa, focal superficial epithelial degeneration, numerous intraepithelial lymphocytes, and a dense lamina propria lymphoplasmacytic infiltrate. Image analysis evaluation of gastric antral biopsies demonstrated a mean thickness of subepithelial collagen of 27.07 micron. Morphologic comparison was made with age-matched control groups of 10 patients who had normal gastric mucosal biopsies and 10 patients who had "chronic" gastritis, which revealed mean subepithelial collagen measures of 1.37 micron and 1.19 micron, respectively. We compared these morphologic findings with those of all previous case reports of collagenous gastritis and propose a pathologic definition based on the limited combined data. It seems that subepithelial collagen is dramatically thickened in reported cases of collagenous gastritis, with a cumulative mean measure of 36.9 micron. It is also apparent from this and previous reports that the thickened subepithelial collagen is accompanied by a chronic or chronic active gastritis and sometimes intraepithelial lymphocytes and surface epithelial damage. Recently described associations of lymphocytic gastritis, sprue, and lymphocytic colitis as well as collagenous and lymphocytic colitis suggest a common pathogenesis that empirically may include collagenous gastritis in the same disease spectrum. We propose that collagenous gastritis can be confidently identified by using analogous defined features of collagenous colitis: subepithelial collagen more than 10 micron in a patchy distribution, lamina propria lymphoplasmacytic infiltrates, intraepithelial lymphocytes, and surface epithelial damage. Collagenous gastritis also seems to have the same spectrum of associated clinical findings as collagenous colitis, including frequent coexistence of celiac sprue, watery diarrhea syndrome, and female predominance.
Collagenous Gastritis A Report of Six Cases Christine Lagorce-Pages, M.D.; Bettina Fabiani, M.D.; Raymonde Bouvier, M.D.; Jean-Yves Scoazec, M.D., Ph.D.; Luc Durand, M.D.; Jean-François Flejou, M.D., Ph.D. From Services d'Anatomie et de Cytologie Pathologiques (C.L.-P.), Hôpital Avicenne, Bobigny; Centre Hospitalier Le Mans (B.F.); Hôpital Edouard Herriot (R.B., J.-Y.S.), Lyon; Hôpital Guy de Chauliac (L.D.), Montpellier; and Hôpital Saint-Antoine (J.-F.F.), Paris, France	Am J Surg Pathol 2001;25:1174-1179 Abstract quote Collagenous gastritis is an exceptional entity with eight cases documented to date characterized by the presence of a thick subepithelial collagen band associated with an inflammatory infiltrate of the gastric mucosa. The aim of our study was to describe the clinical and histologic characteristics of six new cases of collagenous gastritis. All cases showed a subepithelial collagen band that averaged 30 m but often measured up to 120 m. This finding was almost always accompanied by mixed chronic inflammation in the lamina propria and by surface epithelial damage of varying severity. Our study seems to delineate two subsets in patients with collagenous gastritis: 1) collagenous gastritis occurring in children and young adults presenting with severe anemia, a nodular pattern on endoscopy, and a disease limited to the gastric mucosa without evidence of colonic involvement, and 2) collagenous gastritis associated with collagenous colitis occurring in adult patients presenting with chronic watery diarrhea. These findings highlight the fact that subepithelial collagen deposition may be a generalized disease affecting the entire gastrointestinal tract.
VARIANTS

 

PROGNOSIS AND TREATMENT	CHARACTERIZATION
PROGNOSIS
Collagenous Gastritis A Long-Term Follow-up With the Development of Endocrine Cell Hyperplasia, Intestinal Metaplasia, and Epithelial Changes Indeterminate for Dysplasia Jeffrey L. Winslow, MD Thomas D. Trainer, MD and Richard B. Colletti, MD	Am J Clin Pathol 2001;116:753-759 Abstract quote This report reviews the literature pertaining to collagenous gastritis and describes the clinicopathologic evolution of this disease in a patient during a 12-year period. We examined 109 biopsy specimens of gastric mucosa from 19 different endoscopic procedures for the severity and distribution of collagenous gastritis in a single patient. Assessments were undertaken for the presence of endocrine and gastrin cell hyperplasias and dysplastic epithelial changes. Relative to biopsy specimens from age- and sex-matched control subjects, the patient's biopsy specimens showed a significantly lower number of antral gastrin cells, along with a significant corpus endocrine cell hyperplasia, suggesting an increased risk of endocrine neoplasia. Gastric corpus biopsy specimens revealed an active, chronic gastritis, subepithelial collagen deposition, smooth muscle hyperplasia, and mild to moderate glandular atrophy. Additional findings of intestinal metaplasia and reactive epithelial changes indeterminate for dysplasia raise concerns about the potential for adenocarcinoma.

Sternberg S. Diagnostic Surgical Pathology. Third Edition. Lipincott Williams and Wilkins 1999.

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Last Updated 2/2/2004

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