Makindo Medical Notes

Ménétrier Disease (also known as giant hypertrophic gastritis or hyperplastic hypersecretory gastropathy) is a rare, acquired condition characterized by the overgrowth of the mucous cells in the lining of the stomach, leading to large, thickened folds in the stomach’s inner lining

About

• Premalignant condition and 15% develop gastric cancer

Aetiology

• Rugal fold hypertrophy and Hyperplasia of protein containing mucus producing cells
• Hypochlorhydria and Protein losing enteropathy
• Releases large amounts of transforming growth factor-alpha (TGF-a).
• May be a role for Helicobacter and CMV

Clinical

• Abdominal Pain: Often located in the upper abdomen.
• Nausea and Vomiting: Common gastrointestinal symptoms associated with the disease.
• Oedema: Swelling, particularly in the lower extremities, due to protein loss (protein-losing gastropathy).
• Weight Loss: Unintentional weight loss is a common symptom.
• Loss of Appetite: Reduced desire to eat, contributing to weight loss.
• Anaemia: Resulting from chronic gastrointestinal blood loss.

Investigations

• Endoscopy: The primary diagnostic tool, which shows thickened gastric folds, particularly in the fundus and body of the stomach.
• Biopsy: taken during endoscopy reveal characteristic findings, including foveolar hyperplasia and glandular atrophy.
• Imaging: CT scans or upper gastrointestinal series may show enlarged gastric folds.
• Laboratory Tests: Blood tests may reveal hypoalbuminemia (low levels of albumin) due to protein loss, and anaemia.

Management

• Medications:
  • Proton Pump Inhibitors (PPIs): To reduce gastric acid secretion and manage symptoms.
  • Octreotide: A somatostatin analog that can reduce protein loss and improve symptoms.
• Nutritional Support: High-protein diets or intravenous albumin may be necessary to address protein loss.
• Therapeutic Plasma Exchange: In severe cases, to remove circulating growth factors that may contribute to the disease.
• Surgery: Partial or total gastrectomy may be considered in refractory cases or when there is a high risk of malignancy.

References

• Menetrier's Disease