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Surgical Pathology Criteria

Collagenous Gastritis


  • Gastric disorder characterized by a thick collagen layer below the surface basement membrane

Diagnostic Criteria

  • Irregular, thickened collagen layer below the luminal basement membrane
    • Envelops capillaries and inflammatory cells
    • Ragged interface with lamina propria
    • Average thickness 30-40 microns
    • Range 15-129 microns
    • Trichrome stain is useful for demonstration of the layer
  • Lamina propria inflammatory infiltrate
    • Predominantly lymphocytes and plasma cells
    • Fewer neutrophils and eosinophils
  • Intraepithelial lymphocytes variable
    • From normal to 61/100 enterocytes
  • Luminal surface epithelium flattened, may detach
    • Glandular atrophy
  • Involves antrum and/or body
    • May be patchy or diffuse
  • Associated lymphocytic gastritis in 33% of cases
    • May be seen at all ages
  • Adult and pediatric cases may differ in presentation and association with other GI or autoimmune diseases, see Clinical link at left

Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting/last update: 9/9/09, 6/7/15

Differential Diagnosis

  • Radiation
    • Diffuse fibrosis rather than just below basement membrane
  • Scleroderma
    • Fibrosis also around crypts and may be diffuse
  • Artifact of sectioning
    Tangential Sectioning Collagenous Gastritis
    Present only where adjacent glands cut as cross-sections Present even when adjacent glands are cut longitudinally
    Indistinct edges but no entrapped elements Jagged edges with entrapped capillaries and inflammatory cells
    Lacks chronic inflammatory infiltrate Prominent chronic inflammatory infiltrate in lamina propria


  • Most patients fall into one of two distinct groups
    • Children and young adults
      • Age 1-22
      • Present with iron deficiency anemia
      • Endoscopy shows gastric nodularity
      • No associated colitis or autoimmune disorders
    • Adults
  • A recent study (Ma 2015) questions this, finding no significant grouping by age


Gastritis / Gastropathy


  • Lagorce-Pages C, Fabiani B, Bouvier R, Scoazec JY, Durand L, Flejou JF. Collagenous gastritis: a report of six cases. Am J Surg Pathol. 2001 Sep;25(9):1174-9.
  • Leung ST, Chandan VS, Murray JA, Wu TT. Collagenous gastritis: histopathologic features and association with other gastrointestinal diseases. Am J Surg Pathol. 2009 May;33(5):788-98.
  • Srivastava A, Lauwers GY. Pathology of non-infective gastritis.Histopathology. 2007 Jan;50(1):15-29
  • Gopal P, McKenna BJ. The collagenous gastroenteritides: similarities and differences. Arch Pathol Lab Med. 2010 Oct;134(10):1485-9.
  • Suskind D, Wahbeh G, Murray K, Christie D, Kapur RP. Collagenous gastritis, a new spectrum of disease in pediatric patients: two case reports. Cases J. 2009 Jun 10;2:7511.
  • Brain O, Rajaguru C, Warren B, Booth J, Travis S. Collagenous gastritis: reports and systematic review. Eur J Gastroenterol Hepatol. 2009 Dec;21(12):1419-24.
  • Ma C, Park JY, Montgomery EA, Arnold CA, McDonald OG, Liu TC, Salaria SN, Limketkai BN, McGrath KM, Musahl T, Singhi AD. A Comparative Clinicopathologic Study of Collagenous Gastritis in Children and Adults: The Same Disorder With Associated Immune-mediated Diseases. Am J Surg Pathol. 2015 Jun;39(6):802-12.. PubMed PMID: 25871617.
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