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Pathology of Collagenous






Collagenous gastritis is a rare histopathological disorder of unknown origin, characterized by a subepithelial collagen deposit greater than 10 micron thick, associated with an inflammatory infiltrate of the gastric mucosa.

It is related to lymphocytic colitis, collagenous colitis, lymphocytic gastritis and celiac sprue and is probably part of the same disease spectrum.

Since the disease was first reported in 1989, only 60 cases of Collagenous gastritis have been documented in the English literature.

- The patient usually complains of watery diarrhea.

Other clinical  symptoms include  abdominal pain, anemia, nausea and vomiting , body weight loss, abdominal distention, gastrointestinal bleeding, fatigue, retrosternal pain, dyspepsia, perforated ulcer, dysphagia and constipation.

- Endoscopic features include nodular pattern with erythema of the gastric body.

[ "Collagenous gastritis: a report of six cases. Am J Surg Pathol. 2001 Sep;25(9):1174-9.  

1) collagenous gastritis occurring in children and young adults presenting with severe anemia, a nodular pattern on endoscopy, and a disease limited to the gastric mucosa without evidence of colonic involvement, and

2) collagenous gastritis associated with collagenous colitis occurring in adult patients presenting with chronic watery diarrhea.

These findings highlight the fact that subepithelial collagen deposition may be a generalized disease affecting the entire gastrointestinal tract."  ]

Histological features: 

- Subepithelial thickening of basement membrane (greater than 10 microns).

- Focal superficial epithelial degeneration.

- Dense lymphoplasmacytic infiltrate in the lamina propria.

- In some cases numerous intraepithelial lymphocytes may be present.

- The pathological changes are less marked in the nodular mucosal lesions.

Pathological findings suggest that several mucosal biopsies are needed for correct diagnosis, and careful mapping is required for the follow-up of mucosal inflammation and the thickness of collagen deposits.

Collagen deposition can be clearly visualized with Masson Trichrome staining.



Further reading:

Collagenous gastroduodenitis coexisting repeated Dieulafoy ulcer: A case report and review of collagenous gastritis and gastroduodenitis without colonic involvement.

Collagenous gastritis: Review.

Collagenous gastritis: a morphologic and immunohistochemical study of 40 patients.

Clinical outcome of pediatric collagenous gastritis: case series and review of literature.

An unusual case of collagenous gastritis in a middle- aged woman with systemic lupus erythromatosis: a case report.

Clinical outcome of pediatric collagenous gastritis: case series and review of literature.

Collagenous gastroduodenitis with recurrent gastric ulcer in 12-year-old girl.

Collagenous gastritis in the pediatric age.

Collagenous gastritis in a Korean child: a case report.

Collagenous gastritis: a long-term follow-up with the development of endocrine cell hyperplasia, intestinal metaplasia, and epithelial changes indeterminate for dysplasia.


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Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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