Esophagus to Small Intestine
Clin Gastroenterol Hepatol. 2022;20(9):1977–85.e1
Collagenous gastritis: Characteristics and response to topical budesonide
Background and aims: Collagenous gastritis (CG) is a rare disorder characterized by subepithelial collagen deposition in the stomach. Standard medications have been only moderately successful in treating CG. The authors report results of a large, retrospective, open-label non-controlled study of topical budesonide for CG, with an aim of establishing an alternative therapy for the disease.
Methods: They identified patients treated for CG at Mayo Clinic (2000–2017) with topically targeted budesonide (TTB) in 2 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.
Results: 64 patients with CG (50 adults, 14 children) were identified. Most were female (68%), mean age was 41 ± 22.8 years, and body mass index was 23.1 ± 5.9 kg/m². In most pediatric patients, CG presented with abdominal pain and anemia; in adults, CG presented more often with weight loss (p < 0.001). Collagenous sprue or colitis were more common in patients > 50 years of age (83%) versus those 19–50 years of age (27%) or < 19 years of age (50%) (p < 0.001). Of the patients treated with TTB, 89% had a clinical response to TTB (42% complete, 46% partial), and 88% had a histologic response (53% complete, 33% partial).
Conclusions: Adults and children with collagenous gastritis have a wide variety of symptoms, and notably, topically targeted budesonide therapy produced clinical and histologic improvement after other therapy had failed.