Collagenous Sprue, Collagenous Gastritis, and an Uncommon Association with Inflammatory Bowel Disease: A Case Report

Abstract

Celiac disease is the most common cause of intestinal villous atrophy. It may present with a clinical course characterized by chronic diarrhea, malabsorption, and weight loss. Diagnosis is based on the presence of positive specific antibodies in serum, characteristic enteropathy, and the clinical and histological response to a gluten-free diet. However, in some cases, patients with villous atrophy who do not respond to the exclusion of gluten from the diet present a diagnostic and therapeutic challenge. It is essential to perform a differential diagnosis, as different pathologies can mimic celiac disease. The association of celiac disease with other immune-mediated diseases is well known, including inflammatory bowel disease. It is also frequently associated with microscopic colitis, which may be a potential cause of persistent or recurrent symptoms. The clinical course of celiac disease may be complicated by the development of additional conditions such as microscopic colitis, refractory celiac disease or collagenous sprue. Collagenous sprue is a rare enteropathy affecting the small intestine, characterized by the presence of villous atrophy and a thick band of subepithelial collagen. It may be associated with gastritis and lymphocytic and/or collagenous colitis. The literature describes its association with other autoimmune diseases. Complications may include ulceration, perforation, and the development of intestinal lymphoma. Consequently, it has high morbidity and mortality, and a poor prognosis. Knowledge about the natural history, pathogenesis and clinical evolution of collagenous sprue is limited. Some recent publications describe a benign course with a good response to treatment with immunosuppressants. However, the coexistence of celiac disease, inflammatory bowel disease and collagenous sprue is rare, and is presented as isolated case reports.

Case report. We present the case of a 52-year-old male patient diagnosed with collagenous gastroenteritis associated with inflammatory bowel disease, with unfavorable evolution despite treatment.

Conclusion. The report of additional cases of association between collagenous sprue and inflammatory bowel disease could help improve the clinical management of these patients.