Hypertrophic gastritis
Also known as Ménétrier disease and hypoproteinaemic hypertrophic gastropathy
Epidemiology
[edit | edit source]- Rare
Aetiology
[edit | edit source]- Unknown
- Seems to be associated with CMV infection in children and H. pylori in adults
Pathophysiology
[edit | edit source]- Histopathology will show foveolar hyperplasia (expansion of surface mucus cells) with decreased or absent parietal cells
- Associated with protein loss from the stomach, excessive mucus production, and hypochlorhydria or achlorhydria
- Increased levels of transforming growth factor-alpha have been noted in the gastric mucosa of patients with the disease, which can stimulate epithelial cell growth and inhibit gastric acid secretion
- Associated with increased risk of gastric neoplasm (risk estimates vary from 2-15%)
Presentation
[edit | edit source]- Epigastric pain
- Vomiting
- Weight loss
- Decreased appetite
- Peripheral oedema
Workup
[edit | edit source]- Gastroscopy
- Massive gastric folds in the fundus and body of the stomach, giving the mucosa a cobblestone or cerebriform appearance
- Antrum typically spared
- Biopsy the mucosa to establish the diagnosis - need to exclude lymphoma and carcinoma
Management
[edit | edit source]- Inconsistent results
- Acid suppression, octreotide, and CMV/H. pylori eradication have been tried with some success
- Indications for total gastrectomy:
- Patients who continue to have massive protein loss despite optimal medical therapy and high-protein diet
- Dysplasia/carcinoma
Surveillance
[edit | edit source]- Gastroscopy every 1-2 years to look for cancer