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Paediatric Collagenous Gastritis with Transient Response to Steroid Therapy
Rónán O'Connor1, Richard Standish2,3, Hirannya Karunadasa1
1Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia.
Insights
Collagenous gastritis, a rare condition, can cause iron deficiency anemia in young females. While corticosteroids may offer temporary relief, sustained remission of this rare gastric disorder remains challenging.
Area of Science:
- Gastroenterology
- Pathology
Background:
- Collagenous gastritis is a rare disorder characterized by subepithelial collagen deposition and inflammation.
- Its pathogenesis is poorly understood, with limited evidence guiding treatment strategies.
Purpose of the Study:
- To report a case of pediatric collagenous gastritis presenting with iron deficiency anemia.
- To highlight diagnostic and management challenges associated with this rare condition.
Main Methods:
- Case report of a pediatric patient with dyspepsia, nausea, and iron deficiency anemia.
- Diagnostic workup included endoscopy with nodular gastritis findings and histological confirmation.
- Treatment involved budesonide with initial symptomatic improvement.
Main Results:
- Histological examination confirmed collagenous gastritis.
- Budesonide provided temporary symptomatic relief but was not sustained.
- The case underscores the difficulty in achieving sustained clinical or histological remission.
Conclusions:
- Collagenous gastritis should be considered in young patients with unexplained iron deficiency anemia and gastrointestinal symptoms.
- Endoscopy is crucial for diagnosing alternative causes of iron deficiency beyond menstruation.
- Current treatment options, including corticosteroids, offer variable efficacy and transient improvement.
Introduction:
Collagenous gastritis is a rare condition characterised by subepithelial collagen deposition and an inflammatory infiltrate. Despite being first described in 1989, the pathogenesis remains poorly understood. Clinical manifestation and histological features have been extensively described in the literature; however, treatment strategies are largely based on expert opinion and show variable efficacy.
Case Description:
We describe a case of paediatric collagenous gastritis presenting with dyspepsia, nausea and iron deficiency anaemia initially attributed to menorrhagia. Endoscopy demonstrated nodular gastritis and histology confirmed the diagnosis. The patient had initial symptomatic improvement with budesonide; however, this was not sustained.
Conclusion:
This case highlights the importance of considering collagenous gastritis as a cause of iron deficiency anaemia, particularly in young female patients. It also demonstrates the management challenges in achieving sustained clinical response, reflecting the limited evidence base guiding management.
Learning Points:
Collagenous gastritis is a rare but important cause of iron deficiency anaemia, particularly in young patients with persistent gastrointestinal symptoms.Alternative causes of iron deficiency beyond menstruation should be considered in young female patients, with early consideration for endoscopy.Symptomatic improvement with corticosteroids may be transient and sustained clinical or histological remission remains difficult to achieve.
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