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Diagnostic Approach to Pediatric Collagenous Gastritis Based on a Case Series and Literature Review
Wonah Choi1, Yiyoung Kwon1, Yoon Zi Kim1
1Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
Collagenous gastritis (CG) is a rare pediatric condition. Early endoscopy is recommended for children with anemia and GI symptoms unresponsive to treatment, especially if Helicobacter pylori negative.
Area of Science:
- Pediatric Gastroenterology
- Rare Gastrointestinal Disorders
- Histopathology
Background:
- Collagenous gastritis (CG) is a rare pediatric disorder.
- It presents with nonspecific gastrointestinal symptoms and iron-deficiency anemia, often leading to diagnostic delays.
Purpose of the Study:
- To propose a diagnostic algorithm for pediatric Collagenous gastritis.
- To systematically review the published literature on CG.
Main Methods:
- Retrospective analysis of 4 pediatric CG cases from a Korean tertiary center.
- Systematic review of 73 worldwide pediatric CG cases (1989-2024).
Main Results:
- Among 77 cases, 20.8% had only anemia without GI symptoms.
- Abdominal pain (48.7%) and anemia (81.6%) were most common.
- Esophagogastroduodenoscopy often showed nodular or coarse gastric mucosa, less evident early on.
Conclusions:
- Collagenous gastritis is diagnostically challenging, requiring high suspicion.
- Early esophagogastroduodenoscopy is advised for pediatric patients with refractory iron-deficiency anemia and GI symptoms, particularly if H. pylori negative.
- Gastric mucosal nodularity evaluation and biopsies are crucial for diagnosis.
Purpose:
Collagenous gastritis (CG) is a rare pediatric disorder characterized by gastrointestinal symptoms and iron-deficiency anemia. Owing to its low prevalence and broad range of nonspecific manifestations, CG is frequently overlooked during diagnosis. This study aimed to propose a diagnostic algorithm for CG and systematically review the published literature.
Methods:
Four patients aged <18 years diagnosed with CG at a tertiary referral center in Korea between 2003 and 2023 were retrospectively analyzed. In addition, 73 pediatric cases reported worldwide between 1989 and 2024 were reviewed.
Results:
Among 77 cases, excluding one case without symptom data, 16 patients (20.8%) had no gastrointestinal symptoms other than anemia. Abdominal pain was reported in 37 patients (48.7%), gastrointestinal bleeding in five (6.6%), vomiting in nine (11.8%), and diarrhea in three (3.9%). Anemia was present in 62 patients, and 68 tested negative for Helicobacter pylori. Most patients demonstrated nodular or irregularly coarse gastric mucosa on esophagogastroduodenoscopy (EGD), although these findings were less apparent during the early disease stage.
Conclusion:
CG remains a diagnostically challenging condition that requires a high index of suspicion. Early EGD should be considered in pediatric patients with recurrent gastrointestinal symptoms and treatment-refractory iron-deficiency anemia who test negative for H. pylori. Careful evaluation for gastric mucosal nodularity and acquisition of additional histologic biopsies are recommended in these cases.
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