How Best to Treat Collagenous Gastritis?
Vanessa M. Shami, MD, FASGE, reviewing Choung RS, et al. Clin Gastroenterol Hepatol 2021 Dec 2.
Collagenous gastritis (CG) is an uncommon disorder characterized by subepithelial collagen deposition in the stomach. Symptoms vary depending on the phenotype (pediatric-onset vs adult-onset). Treatment in these patients poses a challenge because currently available therapies are often ineffective. The purpose of this large, retrospective, open-label, noncontrolled study was to investigate the effectiveness of topical budesonide for CG.
Patients treated for CG at Mayo Clinic between 2000 and 2017 were identified and included if they had been treated with topically targeted budesonide (TTB). All patients had been given one of two formulations: open-capsule budesonide or compounded immediate-release budesonide capsule.
Demographic, clinical, biochemical, and histologic variables were assessed for all patients before and after treatment. Sixty-four patients with CG (50 adults, 14 children) were included. Sixty-eight percent were female with a mean (SD) age of 41 (22.8) years and body mass index of 23.1 (5.9). Pediatric patients with CG were more likely to present with abdominal pain and anemia, whereas adult patients were more likely to present with weight loss (P<.001). Collagenous sprue or colitis was more common in patients aged older than 50 years (83%) than those aged 19 to 50 years (27%) or younger than 19 years (50%) (P<.001). Of the patients treated with TTB, 89% had a clinical response (42% complete, 46% partial), and 88% had a histologic response (53% complete, 33% partial).
COMMENTAlthough CG is rare, it is important to recognize this disease entity and include it in the differential diagnosis of select adult patients with either weight loss or diarrhea or children with abdominal pain or anemia. When there is a diagnosis of refractory CG, topical budesonide therapy should be considered.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Choung RS, Sharma A, Chedid VG, Absah I, Chen ZME, Murray JA. Collagenous gastritis: characteristics and response to topical budesonide. Clin Gastroenterol Hepatol 2021 Dec 2. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2021.11.033)
