Clinical Management of Proximal Collagenous Gastroenteritides: Systematic Review

Aim: To summarize the latest information of collagenous gastritis and collagenous sprue which in contrast to collagenous colitis is much less recognized and possibly overlooked.
Methods: The systematic review yielded 117 studies comprising 330 patients. No prospective studies or randomized controlled trials were identified.
Results: Proximal collagenous gastroenteritides are benign. Collagenous gastritis should be considered in younger age, whereas collagenous sprue like colitis more often is diagnosed in elderly persons. The collagenous gastroenteritides have an immune or autoimmune basis coupled with a local shift into a collagenous phenotype of the fibroblast lineage within the subepithelium. The anemia in collagenous gastritis may be associated with bleeding from damaged dilated capillaries entrapped in subepithelial fibrous bands. Collagenous gastritis in adults frequently results in a systemic condition (weight loss and diarrhea), whereas endoscopic nodularity caused by mucosal edematous vascular congestion and inflammation seen in youngsters is an uncommon feature.
Conclusions: Gastroenterologists should be aware of the collagenous gastroenteritides when evaluating patients with epigastric pain, dyspepsia, anemia, upper gastrointestinal bleeding, progressive weight loss, and diarrhea, particularly when a gastroscopy shows nodularity of the mucosa. Biopsies are a prerequisite in diagnostics. Anti-secretory strategies including proton pump inhibitors, glucocorticoids and iron supplementation in anemic patients are useful treatment options. Proximal collagenous gastroenteritides belong to a category that has been and will remain underestimated because they are very rare.