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Collagenous gastritis : about two paediatric cases and literature review
O De Ronde1, M Delos2, S Jespers3
1Department of Hepato-Gastro-Enterology, CHU UCL Namur, Godinne, Belgium.
Insights
Proton pump inhibitors (PPIs) with iron supplements effectively treat pediatric collagenous gastritis symptoms like anemia and pain. Histological remission is challenging, and long-term outcomes require further study.
Area of Science:
- Pediatric Gastroenterology
- Rare Gastrointestinal Diseases
- Histopathology
Background:
- Collagenous gastritis is a rare condition affecting children, often presenting with anemia and abdominal pain.
- Therapeutic strategies and long-term outcomes for pediatric collagenous gastritis are not well-established due to a lack of clinical trials.
Purpose of the Study:
- To analyze clinical and histological responses to various treatments in pediatric collagenous gastritis patients.
- To identify the most effective therapeutic approaches for managing this rare condition in children.
Main Methods:
- A systematic review of 43 pediatric patients diagnosed with collagenous gastritis from 1989 to 2019.
- Analysis of clinical and histological data based on treatment choices.
Main Results:
- Clinical response was observed in 85.7% of patients, while histological response occurred in 20.8%.
- Proton pump inhibitors (PPIs) combined with oral iron supplements showed a 78.5% clinical improvement rate.
- Gluten-free diets and corticosteroids also demonstrated good clinical improvement rates, but histological remission was difficult to achieve, with frequent symptom recurrence.
Conclusions:
- Collagenous gastritis in children typically manifests as anemia, abdominal pain, or diarrhea.
- Gastroscopy with fundic biopsies is crucial for diagnosis; PPIs with iron supplements appear most effective for clinical and some histological remission.
- Further research into pathogenesis is needed for targeted therapies to achieve sustained histological remission and understand long-term pediatric outcomes.
Background And Study Aims:
Collagenous gastritis is a rare entity divided in two subgroups (paediatric and adult). In the paediatric population, it often causes anaemia and abdominal pain. Therapy remains the most challenging part as no randomized clinical trial exists and long-term outcome is not well established.
Patients And Methods:
We reviewed the 43 paediatric patients with diagnosis of collagenous gastritis reported in Pubmed from 1989 to mid 2019 to analyse clinical and histological response depending on the treatment choice.
Results:
In 43 patients (M/F ratio 1:2), a clinical response was observed in 85.7% of patients and a histological response in 20.8% of patients. PPI treatment associated with oral iron supplement was the most frequent choice with clinical improvement in 78.5% of patients. Other treatments such as gluten-free diet or corticoids showed relatively good rates of clinical improvement. Histological remission seems difficult to achieve and recurrence of symptoms after treatment interruption was often reported.
Conclusions:
Collagenous gastritis in children is mainly characterized by symptoms of anaemia, abdominal pain or diarrhea. Gastroscopy with fundic biopsies helps to confirm diagnosis and treatment with PPI's (associated with oral iron supplement in case of anaemia) seems to be the most efficient choice to achieve clinical and sometimes histological remission. Long-term outcome of these young patients is unknown. A better understanding of the pathogenesis could lead to new medications focusing on this histological remission.
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