46 Paediatric collagenous gastritis: A case series of a rare disease
Bibliographic record
Abstract
Abstract Background Collagenous gastritis (CG) is a rare gastrointestinal disease whose pathogenesis and adequate treatments are yet to be established. CG is characterized by gastric subepithelial collagen deposition and chronic inflammation on histology. Paediatric CG is particularly understudied, with scarce literature available. We report nine paediatric cases from our tertiary care centre in Québec, Canada. Objectives To describe the clinical presentation, diagnostic challenges and treatment outcomes of paediatric CG. Design/Methods We conducted a retrospective review of paediatric patients diagnosed with CG at our tertiary care centre. Clinical, endoscopic and histopathological data were reviewed. Results Nine patients (ages 9-14 at first presentation) were included. On upper endoscopy, all 9 had nodular gastritis (all negative for Helicobacter pylori infections) with eosinophilic infiltration and subepithelial collagen band on histology compatible with CG. One patient had a type 1 diabetes, one had hypothyroidism and one had a previous episode of Henoch-Schönlein purpura. All patients had at least one or more gastrointestinal symptoms, namely abdominal pain, decreased appetite, weight loss, pyrosis, nausea or vomiting. One patient presented with two episodes of spontaneously-perforated gastric ulcers who underwent gastrorrhaphy with epiploonoplasty and two years later a partial gastrectomy. Four patients presented with severe-to-moderate iron-deficiency anemia (hemoglobin of 26-85 g/L), three of them requiring blood transfusions. Six patients achieved normal hemoglobin levels with oral iron supplements only. Seven patients were prescribed proton pump inhibitors (PPI), while three patients were additionally treated with oral budesonide. One patient remained asymptomatic on daily oral iron supplements. The patient who presented with the most severe iron-deficiency anemia (hemoglobin of 26 g/L), requiring multiple blood transfusions and oral iron supplementation, was treated with oral budesonide and PPI. This patient was found to have resolved CG on repeat endoscopy 3 years later. Conclusion Despite being described as an exceedingly rare disease in the literature, the number of cases reported in our center shows that the entity of CG is probably under-diagnosed. The most common presentation of CG in our paediatric population was iron-deficiency anemia with nodular gastritis seen on endoscopic evaluations. Regular monitoring and tailored treatment are crucial to manage CG in paediatric patients. Further research is needed to understand the pathogenesis and optimal management of this condition.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".