gastrointestinal disorders
Uncommon Gastritis Syndromes
Ménétrier Disease
This rare idiopathic disorder affects adults aged 30 to 60 and is more common among men. It manifests as a significant thickening of the gastric folds of the gastric body but not the antrum. Gland atrophy and marked foveolar pit hyperplasia occur, often accompanied by mucous gland metaplasia and increased mucosal thickness with little inflammation. Hypoalbuminemia (the most consistent laboratory abnormality) caused by gastrointestinal protein loss may be present (protein-losing gastropathy). As the disease progresses, the secretion of acid and pepsin decreases, causing hypochlorhydria. Symptoms of Ménétrier disease are nonspecific and commonly include epigastric pain, nausea, weight loss, edema, and diarrhea. Diagnosis of Ménétrier disease is made by endoscopy with deep mucosal biopsy or full-thickness laparoscopic gastric biopsy. Differential diagnosis includes the following: Lymphoma, in which multiple gastric ulcers may occur Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma , with extensive infiltration of monoclonal B lymphocytes Gastrinoma (Zollinger-Ellison syndrome) with associated gastric fold hypertrophy Cronkhite-Canada syndrome, a mucosal polypoid protein-losing syndrome associated with diarrhea Various treatments have been used, including anticholinergics, antisecretory medications, and corticosteroids, but none have proved fully effective. Partial or complete gastric resection may be necessary in cases of severe hypoalbuminemia. 