PMC5872668_01
Endoscopic photos of the body of the stomach show diffusely nodular mucosa (a) with deep linear ulcers (arrows) and severe inflammation and hemorrhage (b).
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fig1
The gastric fundus and body appeared atrophic with friable and severely inflamed mucosa and multiple linear ulcers without active bleeding (Figure 1).
20x magnification: (a) hematoxylin and eosin-stained section of the gastric body shows a thick, markedly irregular pink band of subepithelial collagen deposition with complete surface erosion. The mucosa is inflamed and atrophic with loss of parietal cells. Arrows indicate entrapped capillaries. (b) Trichrome stain highlights the collagen blue.
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fig2
The biopsies of the antrum and body showed increased subepithelial collagen deposition confirmed on a trichrome stain, chronic inflammation in the lamina propria, surface epithelial regenerative changes, and erosions, consistent with collagenous gastritis (Figure 2).
20x magnification: (a) hematoxylin and eosin-stained section of the duodenum shows villous shortening/partial atrophy with increased subepithelial collagen deposition (pink). (b) Trichrome stain highlights the collagen blue. Arrows indicate entrapped capillaries.
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fig3
The biopsies of the duodenum showed partial villous atrophy and increased subepithelial collagen deposition confirmed on a trichrome stain, consistent with collagenous duodenitis/sprue (Figure 3).
Endoscopic photos of the body of the stomach 7 weeks after cessation of olmesartan show atrophic mucosa with few residual areas of erythema (arrow) and complete resolution of the ulcers.
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fig4
Follow-up EGD 7 weeks later showed somewhat atrophic gastric mucosa with few residual linear areas of erythema and complete resolution of the ulcers, inflammation, and mucosal friability (Figure 4).