A 12-year-old girl presented with vomiting and generalized abdominal pain of one year duration, with no clockwise predominance or relationship to eating habits other than constipation at night.
It is not associated with weight loss or changes in bowel habit.
Personal history without interest.
Complete blood count was performed with hemoglobin 12.6 g/dl, mean corpuscular volume 79.6%.
The rest of the blood count is normal.
In addition, liver function showed normal AST, ALT and GGT and renal function without alterations.
Ferritin is fertile with a concentration of 9 ng/ml (20-200 ng/ml) without elevation of acute phase reactants (C-reactive protein and erythrocyte sedimentation rate).
Screening for celiac disease with total IgA, antitransglutaminase antibodies (IgA-AAT), anti-deaminated gliadin peptide antibodies that are negative and HLA DQ2-D is performed.
In addition, food challenge with total IgE and specific to cow's milk protein (PLV) and egg were negative.
After normal results, upper endoscopy had been performed in another hospital with a diagnosis of gastritis, with rapid urease test in antral biopsy negative for Helicobacter pylori infection.
No other gastric samples were taken for pathological study.
Treatment with high doses of PPIs (2 mg/ kg/day) was initiated, with initial improvement and relapse after PPI discontinuation at 2 months.
Re-consultation in our center due to persistence of symptoms, more localized and intensified epigastric pain in the last month.
A new upper endoscopy showed only nodular image in the gastric antrum.
Samples of gastric antrum were taken for rapid urease test for Helicobacter pylori which is negative and pathological study.
The histological description highlights the presence of gastric mucosa with moderate lymphocytic inflammatory component together with the presence of collagen-epithelial fibrosis patchy distribution that exceeds the glands are distributed in areas of thickness and are also distributed around the glands.
No significant intraepithelial lymphocytosis or Helicobacter pylori were observed.
Samples from the esophagus and duodenum do not present histological alterations.
Oriented as GC is performed to rule out associated collagen colitis which is normal both image and histologically.
Treatment with oral esomeprazole 40 mg every 24 hours is restarted, symptoms disappear within a few days with oral iron supplementation.
After 3 months of treatment initiation, the dose of PPI may be reduced to asymptomatic half, 6 months after diagnosis.
