Kang Ben, Um Soo Hyun, Yun Jaehun, Kim Hee Kyung, Choe Byung-Ho, Lee Yoo Min
Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea.
Transl Pediatr. 2021 Nov;10(11):3096-3103. doi: 10.21037/tp-21-342.
Collagenous gastritis (CG) is a rare disease diagnosed histologically by the subepithelial deposition of collagen bands thicker than 10 µm and the infiltration of inflammatory mononuclear cells in the lamina propria. The definite pathophysiology is yet to be elucidated. However, recent studies have suggested that the collagen deposition may be the result of a reparative process in response to an earlier inflammatory, autoimmune, infectious, or toxic insult. CG is divided into the pediatric- and adult-type. While the pediatric-type is limited to the stomach, the adult-type involves not only the stomach but also the intestine and/or colon. We report a rare case of adult-type CG in a 15-year-old boy who initially presented with abdominal pain and iron-deficiency anemia. Esophagogastroduodenoscopy (EGD) revealed findings suspicious for () gastritis. Although histology did not reveal the organism, campylobacter-like organism (CLO) test was positive. Based on the diagnosis of suspicious gastritis, eradication was conducted using the triple drug regimen. However, symptoms of intermittent abdominal pain persisted and diarrhea newly developed one year later. Histologic results from biopsies from the stomach, duodenum, and colon revealed findings compatible with CG, collagenous duodenitis (CD), and collagenous colitis (CC). This is the first pediatric case of collagenous gastroduodenocolitis (CGDC) reported in Asia. It is no longer assumed that adult-type and pediatric-type CG should be classified as an independent disease, but should be considered as similar diseases on a continuous spectrum. Therefore, children and adolescents diagnosed with CG should also consider undergoing a colonoscopy for the evaluation of possible coexisting CC when concurrent lower gastrointestinal symptoms are present. Moreover, considering the possibility of negative findings on the first endoscopy, repeat endoscopy should be considered when symptoms persist.
胶原性胃炎（CG）是一种罕见疾病，通过组织学诊断，其特征为上皮下有厚度超过10 µm的胶原带沉积以及固有层中有炎性单核细胞浸润。确切的病理生理学尚待阐明。然而，最近的研究表明，胶原沉积可能是对早期炎症、自身免疫、感染或毒性损伤的修复过程的结果。CG分为儿童型和成人型。儿童型仅限于胃部，而成人型不仅累及胃部，还涉及小肠和/或结肠。我们报告了一例罕见的15岁成人型CG病例，该男孩最初表现为腹痛和缺铁性贫血。食管胃十二指肠镜检查（EGD）显示有疑似（）胃炎的表现。尽管组织学检查未发现病原体，但弯曲杆菌样菌（CLO）检测呈阳性。基于疑似胃炎的诊断，采用三联药物疗法进行根除治疗。然而，间歇性腹痛症状持续存在，一年后又新出现腹泻。胃、十二指肠和结肠活检的组织学结果显示符合胶原性胃炎（CG）、胶原性十二指肠炎（CD）和胶原性结肠炎（CC）的表现。这是亚洲报道的首例儿童胶原性胃十二指肠结肠炎（CGDC）病例。不再认为成人型和儿童型CG应归类为独立疾病，而应视为连续谱系上的相似疾病。因此，诊断为CG的儿童和青少年在出现并发的下消化道症状时，也应考虑进行结肠镜检查以评估可能并存的CC。此外，考虑到首次内镜检查可能出现阴性结果，当症状持续时应考虑重复内镜检查。
