Menetrier’s disease

Menetrier’s disease

Menetrier’s disease is a relatively rare disorder of the stomach characterized by lar e tortuous mucosal folds

Etiology

•   Etiology is unknown

•   Over expression of growth factors such as TGF are suggested

Pathology

Gross

•   Marked Hypertrophy of gastric folds/Rugaee

•   Hypertrophy results from hyperplasia of mucus producing cells (mucosa)Q

•   Hypertrophy is most prominent in the body and fundus °

Histological/microscopic

•   Massive foveolar hyperplasia (Hyperplasia of surface and glandular mucosal cells).

•   Pits of gastric glands elongate and may become tortuous

•   Lamina propria may contain a mild chronic inflammatory infiltrate

(Note: Although lamina propria may contain an inflammatory infiltrates, Menetrier’s disease is not considered a

form of gastritis

Clinical picture

•   Protein losing enteropathy is characteristic

Excessive protein is lost from the thickened mucosa into the gut which results in hypoprotenemia and edema

•   Gastric acid secretion is usually reduced or absent

This happens because mucosal cell hyperplasia replaces most of the parietal cells.

•   Epigastric pain accompanied by nausea, vomiting anorexia and weight loss

Overt bleeding is unusual but occult gastrointestinal bleeding may occur

Differential Diagnosis

DD includes conditions that may present with large gastric folds:

ZES

Malignancy

Infiltrative disorders eg sarcoidosis

Infectious etiology (CMV, Histoplasmosis, syphilis)

Prognosis

These is an increased risk of adenocarcinoma of stomach in adults with menetrier’s disease (CSDT)