Esophagus to Small Intestine

Clin Gastroenterol Hepatol. 2022;20(9):1977–85.e1

Choung RS, Sharma A, Chedid VG, Absah I, Chen ZE, Murray JA

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.

J.A. Murray, M.D., Professor of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA,

DOI: 10.1016/j.cgh.2021.11.033

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