Pediatric Collagenous Gastroenterocolitis Successfully Treated with Methotrexate

Protein-losing enteropathy secondary to collagenous colitis in a 2-year-old

Protein-losing enteropathy associated with collagenous colitis (CC) is a rare but described entity in the adult population. However, literature regarding this in the pediatric population is scarce. Here we describe a 2-year-old female who presented with fevers, accompanied by nonbloody, watery diarrhea, and decreased oral intake. Work-up was significant for severe hypoalbuminemia at 1.5 grams per deciliter (g/dL), pancytopenia, and elevated fecal alpha-1-antitrypsin at 1.13 milligrams per grams (mg/g). Gastrointestinal mucosal evaluation was normal endoscopically; however, histology was consistent with CC. She responded to 12-week treatment with budesonide with resolution of symptoms and laboratory values. At this point, she has not had a recurrence 1 year later.

Collagenous gastroduodenocolitis in a Korean adolescent: first pediatric case report in Asia

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 Helicobacter pylori (H. pylori) gastritis. Although histology did not reveal the organism, campylobacter-like organism (CLO) test was positive. Based on the diagnosis of suspicious H. pylori 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.