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Genta RM, Rugge M. Host-related low-prevalence gastritides: Epidemiological and clinical characterization. Dig Liver Dis 2024:S1590-8658(24)00714-X. [PMID: 38705782 DOI: 10.1016/j.dld.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION A recent consensus meeting (RE.GA.IN) addressed "host-related, low-prevalence gastritis": eosinophilic (EoG), lymphocytic (Hp-pos_LyG and Hp-neg_LyG), collagenous (CollG), and granulomatous gastritis (GrG). Our study evaluates their clinico-epidemiological characteristics. MATERIALS AND METHODS We extracted all patients with a diagnosis of EoG, LyG, CollG, and GrG from a clinicopathological database and compared their demographics, clinical and endoscopic characteristics, associated conditions, and clinical awareness to those of all other subjects in the database (controls). RESULTS There were 1,781,005 unique patients (median age 57 years; 55.7 % female). Hispanics were overrepresented amongst those with Hp-pos_LyG. Subjects with GrG had a high prevalence of erosions and ulcers. Clinical awareness of these conditions was dismal (<1:10,000 patients). Some clinical manifestations were more common in patients with certain gastritides (e.g., vomiting and diarrhea in CollG; anemia in LyG), but none were sufficiently distinctive to suggest a clinical diagnosis. EoG was associated with EoE; LyG had a strong association with celiac disease; CollG with microscopic colitis; and GrG with Crohn disease. CONCLUSIONS The diagnosis of these gastritides (between <1: in 1,000 and 1 in 5000 subjects) rests on histopathology. They remain poorly characterized and clinically neglected. Yet, their associations may herald other conditions: eosinophilic gastrointestinal diseases (EGID), celiac, and Crohn disease. Patients might benefit from increased detection and characterization.
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Affiliation(s)
- Robert M Genta
- Inform Diagnostics, Irving, TX, USA; Departments of Pathology and Medicine (Gastroenterology), Baylor College of Medicine, Houston, TX, USA.
| | - Massimo Rugge
- Department of Pathology, University of Padova, Padova, Italy
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2
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Shi W, Jiao Y. Ménétrier's disease. QJM 2023; 116:802-803. [PMID: 37220896 DOI: 10.1093/qjmed/hcad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Indexed: 05/25/2023] Open
Affiliation(s)
- W Shi
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Y Jiao
- Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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3
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Affiliation(s)
- Ahmet Ozen
- From the Department of Pediatrics, Division of Allergy and Immunology, Marmara University, School of Medicine, the Istanbul Jeffrey Modell Diagnostic Center for Primary Immunodeficiency Diseases, and the Isil Berat Barlan Center for Translational Medicine - all in Istanbul, Turkey (A.O.); and the Molecular Development of the Immune System Section, Laboratory of Immune System Biology, Clinical Genomics Program, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.J.L.)
| | - Michael J Lenardo
- From the Department of Pediatrics, Division of Allergy and Immunology, Marmara University, School of Medicine, the Istanbul Jeffrey Modell Diagnostic Center for Primary Immunodeficiency Diseases, and the Isil Berat Barlan Center for Translational Medicine - all in Istanbul, Turkey (A.O.); and the Molecular Development of the Immune System Section, Laboratory of Immune System Biology, Clinical Genomics Program, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.J.L.)
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4
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Kmiecik M, Walczak A, Samborski P, Paszkowski J, Dobrowolska A, Karczewski J, Swora-Cwynar E. Upper gastrointestinal bleeding as an unusual manifestation of localized Ménétrier’s disease with an underlying lipoma: A case report. World J Gastrointest Endosc 2023; 15:10-18. [PMID: 36686066 PMCID: PMC9846829 DOI: 10.4253/wjge.v15.i1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/16/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Ménétrier’s disease is a rare condition characterized by enlarged gastric folds, usually located in the whole body and fundus of the stomach. This report presents an unusual case of localized Ménétrier’s disease elevated by a submucosal lipoma and thus looking like a polypoid mass and causing an episode of upper gastrointestinal bleeding. The mass was successfully removed with endoscopic submucosal dissection.
CASE SUMMARY Esophagogastroduodenoscopy was performed on a 76-year-old male patient after an episode of upper gastrointestinal bleeding, manifesting as fatigue and melena. A large polypoid mass (4 cm × 1 cm) with enlarged mucosal folds was found in the body of the stomach, between the lesser curvature and posterior wall. A small ulcer at the distal end of the mass was identified as the source of the bleeding. Biopsy was negative for neoplasia. Computed tomography showed a submucosal lesion beneath the affected mucosa, most likely a lipoma. The mass was removed en bloc with tunneling endoscopic submucosal dissection. Final pathology determined that the mass included Ménétrier’s disease and a submucosal lipoma. The patient was scheduled for follow-up esophagogastroduodenoscopy.
CONCLUSION Localized Ménétrier’s disease can coexist with a submucosal lipoma creating a polypoid mass with risk of bleeding.
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Affiliation(s)
- Michal Kmiecik
- Department of Gastroenterology, Nutrition and Internal Medicine, Poznan University of Medical Sciences, Poznan 60-355, Poland
| | - Aleksandra Walczak
- Department of Clinical Pathology, Poznan University of Medical Sciences, Poznan 60-355, Poland
| | - Pawel Samborski
- Department of Gastroenterology, Nutrition and Internal Medicine, Poznan University of Medical Sciences, Poznan 60-355, Poland
| | - Jacek Paszkowski
- Department of General & Endocrine Surgery, and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan 60-355, Poland
| | - Agnieszka Dobrowolska
- Department of Gastroenterology, Nutrition and Internal Medicine, Poznan University of Medical Sciences, Poznan 60-355, Poland
| | - Jacek Karczewski
- Department of Gastroenterology, Nutrition and Internal Medicine, Poznan University of Medical Sciences, Poznan 60-355, Poland
| | - Ewelina Swora-Cwynar
- Department of Gastroenterology, Nutrition and Internal Medicine, Poznan University of Medical Sciences, Poznan 60-355, Poland
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5
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Ramrakhiani H, Triadafilopoulos G. Erasing Giant Folds: Ménétrier's Disease Treated with Cetuximab. Dig Dis Sci 2022; 67:5006-5009. [PMID: 36125594 DOI: 10.1007/s10620-022-07692-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 01/05/2023]
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6
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Ramrakhiani H, Triadafilopoulos G. Erasing Giant Folds: Ménétrier's Disease Treated with Cetuximab. Dig Dis Sci 2022. [PMID: 36125594 DOI: 10.1007/s10621-021-07373-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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7
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Cilento SV, Sypek S, Hammond P. Do not trust your gut: A rare cause of oedema in a 3-year-old. J Paediatr Child Health 2021; 57:1316-1318. [PMID: 32914918 DOI: 10.1111/jpc.15177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sophie V Cilento
- Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia
| | - Scott Sypek
- Department of General Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Paul Hammond
- Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia.,Department of Gastroenterology, Women's and Children's Hospital, Adelaide, South Australia, Australia
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A Misdiagnosed Case of Hypertrophic Gastropathy. Case Rep Pathol 2020; 2020:4562531. [PMID: 33343956 PMCID: PMC7725578 DOI: 10.1155/2020/4562531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 11/17/2022] Open
Abstract
Hypertrophic gastropathy is a rare idiopathic hyperproliferative disorder which may present as Menetrier's disease (MD) characterized by foveolar hyperplasia in the gastric fundus and body. It is often accompanied by a severe loss of plasma proteins (including albumin) from the altered gastric mucosa. The disease occurs in two forms, a childhood form due to cytomegalovirus infection and an adult form attributed to overexpression of transforming growth factor-alpha (TGF-α). The most common symptoms include epigastric pain with fullness and vomiting and generalized peripheral edema with hypoalbuminemia. We present a case of 75-year-old female presenting with epigastric pain and vomiting. Upper gastrointestinal endoscopy and computed tomography scan revealed an irregular mucosal fold at the body and antrum and thickening of the stomach wall, respectively. Though the endoscopic gastric mucosal biopsy was nonspecific, the patient underwent partial gastrectomy due to clinicoradiological suspicion of carcinoma. On histopathology, the case was reported as hypertrophic gastropathy, consistent with MD. Though there is a strong clinical and radiological suspicion of malignancy in the hypertrophied gastric mucosa, MD should be one of the important differential diagnoses.
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Waisberg DR, de Mello ES, Tustumi F, Szor DJ, Charruf AZ, Fuhro FE, Waisberg J, Dias AR. A case report of diffuse hyperplastic gastropathy with multiple polypoid formations in a patient with pernicious anemia, Helicobacter pylori infection, hypergastrinemia and hypoalbuminaemia: Do not forget of Ménétrier's disease. Int J Surg Case Rep 2020; 77:498-502. [PMID: 33395833 PMCID: PMC7700994 DOI: 10.1016/j.ijscr.2020.11.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Ménétrier's disease is a rare condition, frequently associated with Helicobacter pylori infection, hypergastrinemia and hypoalbuminaemia. PRESENTATION OF THE CASE A case of a 55 years-old female patient with a previous diagnosis of pernicious anemia complaining of epigastric discomfort, hyporexia, vomiting, and weight loss is reported. Endoscopy showed multiple gastric polyploid formations and Helicobacter pylori infection was detected. Laboratory tests showed elevated gastrin serum levels and presence of antibodies antiparietal cells, as well as microcytic hypochromic anemia compatible with chronic iron deficiency. Albumin serum level was slightly decreased. Full thickness biopsy performed via echoendoscopy reported gastritis cystica/polyposa profunda. Given the association of diffuse involvement of the entire stomach, the possibility of developing malignant disease and the clinical symptoms, the patient underwent laparoscopic total gastrectomy with Roux-en-Y reconstruction. The surgical specimen showed the mucosa hyperemic and swollen, with prominent gastric folds. Hyperplastic elongation of gastric foveolas associated with disappearance of oxyntic glands was compatible with Ménétrier's disease. DISCUSSION The Ménétrier's disease diagnosis may be tricky, especially when an unusual endoscopic presentation is associated with other conditions that may mislead the diagnostic evaluation. The differential diagnoses were gastric malignancies, Zollinger-Ellison syndrome, massive gastric polyposis and gastritis cystica/polyposa profunda. CONCLUSION Clinical, laboratory, endoscopic and histopathological findings are paramount for reaching the diagnosis of Ménétrier's disease, but it should be suspected in all cases of upper gastrointestinal symptoms and hypertrophied gastric mucosa.
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Affiliation(s)
- Daniel Reis Waisberg
- Department of Surgery, Hospital de Clínicas Municipal José Alencar, Sao Bernardo do Campo, Brazil
| | | | - Francisco Tustumi
- Department of Surgery, Hospital de Clínicas Municipal José Alencar, Sao Bernardo do Campo, Brazil.
| | - Daniel José Szor
- Department of Surgery, Hospital de Clínicas Municipal José Alencar, Sao Bernardo do Campo, Brazil
| | - Amir Zeide Charruf
- Department of Surgery, Hospital de Clínicas Municipal José Alencar, Sao Bernardo do Campo, Brazil
| | - Felipe Emanuel Fuhro
- Department of Surgery, Hospital de Clínicas Municipal José Alencar, Sao Bernardo do Campo, Brazil
| | - Jaques Waisberg
- Digestive and General Surgery Department, ABC Medical School (FMABC), Santo Andre, Brazil
| | - André Roncon Dias
- Department of Surgery, Hospital de Clínicas Municipal José Alencar, Sao Bernardo do Campo, Brazil
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10
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Murakami M, Heng HG, Lim CK, Parnell NK, Sola M. Ultrasonographic features and prevalence of presumed gastric wall edema in dogs with hypoalbuminemia. J Vet Intern Med 2020; 34:1867-1871. [PMID: 32609407 PMCID: PMC7517500 DOI: 10.1111/jvim.15829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/14/2020] [Accepted: 05/21/2020] [Indexed: 12/25/2022] Open
Abstract
Background Ultrasonographic features of gastric wall edema have not been reported in dogs with hypoalbuminemia. Objectives To describe the prevalence and ultrasonographic features of gastric wall thickening in dogs with hypoalbuminemia and analyze correlation with serum albumin concentrations. Animals Forty‐two dogs with abdominal ultrasound and diagnosis of hypoalbuminemia (<2.3 g/dL). Methods Retrospective search in the medical records from 2018 to 2019 was performed. Ultrasound studies were reviewed and >5 mm were considered gastric wall thickening. The gastric wall changes such as thickness, layering appearance, echogenicity, echotexture, distribution of lesions, and presence of peritoneal effusion were recorded. Serial ultrasonographic examination and histopathological findings were recorded if available. Mean serum albumin concentration of dogs with and without gastric wall thickening was compared. Results Prevalence of gastric wall thickening in dogs with hypoalbuminemia was 21.4% (95% confidence intervals 7.4‐35.4%). Mean gastric wall thickness was 10.0 ± 2.0 mm. Preserved mucosal layer and thickening of submucosal layer were observed in all 9 dogs. Five dogs had 3‐layer appearance in thickened submucosal layer. Diffuse wall thickening was observed in 6 dogs. All 9 dogs had peritoneal effusion. Subsequent changes of gastric wall thickening were observed in 3 dogs (range 4‐70 days). Gastric wall edema was confirmed histopathologically in 2 dogs via necropsy. There was no correlation between serum albumin concentration of the dogs and gastric wall thickness. Conclusions and clinical importance Findings indicated that gastric wall edema is a common finding in dogs with hypoalbuminemia. However, serum albumin concentrations did not correlate with the gastric wall thickness.
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Affiliation(s)
- Masahiro Murakami
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - Hock Gan Heng
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - Chee Kin Lim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - Nolie K Parnell
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - Mario Sola
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, USA
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11
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Abstract
PURPOSE OF REVIEW The present review offers its readers a practical overview of protein-losing enteropathy, particularly with regard to diagnostic and therapeutic approaches. The aim is to support clinicians in their daily practice with a practical tool to deal with protein-losing enteropathy. RECENT FINDINGS The literature covering protein-losing enteropathy does not appear to be quite recent and also guidelines are scanty. The main innovations during the last decade probably regard the introduction of enteroscopic techniques in the diagnostic flowchart. The use of video-capsule and device-assisted enteroscopy has enabled the direct exploration of the small bowel and the identification of the damage causing the loss of proteins from the gastrointestinal tract. Other innovations are to do with the therapies of the disorder underlying protein-losing enteropathy, although the support with nutritional supplementation are the direct remedies to tackle the protein loss. SUMMARY Protein-losing enteropathy represents an important clinical aspect of different gastrointestinal and extra-intestinal diseases. An established flowchart is still unavailable, but the use of enteroscopy has deeply changed the modern diagnostic approach. Nutritional support and therapy of the underlying disease are pivotal to patients' management.
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12
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Parianos C, Aggeli C, Sourla A, Zografos GN. Total gastrectomy for the treatment of Menetrier's disease persistent to medical therapy: A case report. Int J Surg Case Rep 2020; 73:95-99. [PMID: 32653837 PMCID: PMC7355377 DOI: 10.1016/j.ijscr.2020.06.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Menetrier's disease is a rare hyperproliferative protein-losing gastropathy of the gastric foveolar epithelium. It is characterized by giant hypertrophic folds, excess mucus secretion, decreased acid secretion and hypoproteinemia due to selective loss of serum proteins across the gastric mucosa. The discovery of transforming growth factor-α overexpression opened the way of epidermal growth factor receptor blockade with cetuximab as first-line treatment modality for Menetrier's disease. CASE REPORT- ETHODS We present the case of a 46-year-old female patient with Menetrier's disease. The diagnosis was based on clinical, endoscopic and histological criteria. Two years before the diagnosis of the disease the patient had an episode of deep vein thrombosis and pulmonary embolism. Real time PCR revealed mutation of the gene responsible for coagulation factor II. The patient received anticoagulation therapy and after a period of 6 months a severe anemia due to a gastrointestinal bleeding was presented. The appropriate investigation revealed the presence of Menetrier's disease. The patient was referred to the surgical clinic with persistence of symptoms such as excessive weight loss, anemia and weakness, even after multiple medical treatment, including the monoclonal antibody against the EGFR receptor. A total gastrectomy was performed and the postoperative course was uneventful. One year follow up showed remarkable improvement of her health status. CONCLUSION A combination of clinical, laboratory, endoscopic and histopathologic findings is necessary for the diagnosis of this rare disease. Gastrectomy is the treatment of choice for those patients with intractable symptoms and signs refractory to medical therapy.
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Affiliation(s)
- Christos Parianos
- 3rd Department of Surgery, General Hospital Of Athens 'G.Gennimatas", Greece.
| | - Chrysanthi Aggeli
- 3rd Department of Surgery, General Hospital Of Athens 'G.Gennimatas", Greece.
| | - Antigoni Sourla
- Pathology Department Medical School, University of Athens, Athens, Greece.
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Total gastrectomy for the treatment of Menetrier’s disease persistent to medical therapy: A case report. Int J Surg Case Rep 2020. [DOI: 10.1016/j.ijscr.2020.06.033
expr 837030795 + 981493009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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14
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Barker EN, Holdsworth AS, Hibbert A, Brown PJ, Hayward NJ. Hyperplastic and fibrosing gastropathy resembling Ménétrier disease in a cat. JFMS Open Rep 2019; 5:2055116919861248. [PMID: 31308958 PMCID: PMC6607575 DOI: 10.1177/2055116919861248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Case summary A 3.5-year-old domestic shorthair cat presented with a 6 month history of weight loss and polyphagia. Clinical examination revealed a markedly reduced body condition score (2/9) and a quiet demeanour. Laboratory abnormalities comprised a mild non-regenerative anaemia, stress leukogram, hypoproteinaemia due to hypoalbuminaemia, azotaemia, hypokalaemia, total hypocalcaemia and sub-maximally concentrated urine (specific gravity 1.020). Abdominal ultrasonography revealed marked thickening of the gastric mucosa within the fundus, body and pylorus; the most dorsal portion of the fundus was spared. The thickened mucosa contained multiple small, anechoic cyst-like structures. The gastric submucosa, muscularis and serosa appeared normal. Histopathology, performed on a full-thickness gastric biopsy, revealed mucosal hypertrophy and markedly dilated gastric glands in areas; not all gastric glands were affected, with some appearing normal or atrophic. Focal interstitial fibrosis was present in some areas. The findings of hypoproteinaemia, gastric ultrasonographic changes and histopathology results share several similarities to those reported with Ménétrier disease. Relevance and novel information Ménétrier disease is a rare condition of the stomach in humans. A similar condition, giant hypertrophic gastritis (or Ménétrier-like disease), has also been described rarely in dogs. To our knowledge, Ménétrier-like disease has not been previously described cats. This case shares features of Ménétrier-like disease, raising the suspicion of a similar aetiopathogenesis.
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Affiliation(s)
- Emi N Barker
- The Feline Centre, Langford Vets, Langford, Bristol, UK
| | | | - Angie Hibbert
- The Feline Centre, Langford Vets, Langford, Bristol, UK
| | - Peter J Brown
- Bristol Veterinary School, University of Bristol, Langford, Bristol, UK
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Greenblatt HK, Nguyen BK. Ménétrier's disease presenting as recurrent unprovoked venous thrombosis: a case report. J Med Case Rep 2019; 13:14. [PMID: 30651128 PMCID: PMC6335789 DOI: 10.1186/s13256-018-1952-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/12/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Acquired thrombophilia is a potential sequela of malignancy, chronic inflammation, and conditions characterized by severe protein deficiency (for example, nephrotic syndrome, protein-losing enteropathy). As such, venous thrombosis is often a feature, and occasionally a presenting sign, of systemic disease. Ménétrier's disease is a rare hyperplastic gastropathy that may lead to gastrointestinal protein loss and hypoalbuminemia. To date, reports of venous thrombosis associated with Ménétrier's disease are exceedingly scarce. CASE PRESENTATION We report the case of a 40-year-old white man who presented with unprovoked deep venous thrombosis, pulmonary embolism, and renal vein thrombosis. Upon receiving therapeutic anticoagulation, he developed severe gastrointestinal bleeding, and endoscopic evaluation led to a diagnosis of Ménétrier's disease. A laboratory workup revealed deficiency of protein C, protein S, and antithrombin III, as well as markedly elevated levels of factor VIII. He was determined to have an acquired thrombophilia as a direct result of Ménétrier's disease. CONCLUSIONS This case describes an acquired thrombophilic state in a patient with Ménétrier's disease and profound hypoalbuminemia. Although this association is rarely described, we discuss the probable mechanisms leading to our patient's thrombosis. Specifically, we posit that his gastrointestinal protein loss led to a deficiency of several anticoagulant proteins and a compensatory elevation in factor VIII, as occurs in nephrotic syndrome and inflammatory bowel disease. Of note, this patient's recurrent venous thrombosis was the initial clinical sign of his gastrointestinal pathology.
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Affiliation(s)
| | - Brave K. Nguyen
- University of Cincinnati College of Medicine, Cincinnati, OH 45219 USA
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16
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Metz DC, Cadiot G, Poitras P, Ito T, Jensen RT. Diagnosis of Zollinger-Ellison syndrome in the era of PPIs, faulty gastrin assays, sensitive imaging and limited access to acid secretory testing. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2017; 4:167-185. [PMID: 29326808 DOI: 10.2217/ije-2017-0018] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In recent years the diagnosis of Zollinger-Ellison syndrome (ZES) has become increasingly controversial with several new approaches and criteria proposed, differing from the classical biochemical criterion of inappropriate hypergastrinemia (i.e., hypergastrinemia in the presence of hyperchlorhydria) (Table 1). These changes have come about because of the difficulty and potential dangers of stopping proton pump inhibitors (PPIs) for gastric acid analysis; the recognition than many of the current assays used to assess gastrin concentrations are unreliable; the development of sensitive imaging modalities that detect neuroendocrine tumors (NETs) including an increasing number of the primary gastrinomas; the increased use of percutaneous or endoscopic ultrasound (EUS)-directed biopsies/cytology and the general lack of availability of acid secretory testing. In this article we will discuss the basis for these controversies, review the proposed changes in diagnostic approaches and make recommendations for supporting the diagnosis of ZES in the modern era.
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Affiliation(s)
- David C Metz
- Division of Gastroenterology, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, PA, 19104, USA
| | - Guillaume Cadiot
- Service d"Hepato-Gastroenterologie, Centre Hospitalier Universitaire de Reims, Hopital Robert Debre, F-51092, Reims, France
| | - Pierre Poitras
- Department of Gastroenterology, CHUM, Université de Montréal, Montreal, Canada
| | - Tetsuhide Ito
- Neuroendocrine Tumor Centra, Fukuoka Sanno Hospital, International University of Health and Welfare 3-6-45 Momochihama, Sawara-Ku, Fukuoka 814-0001, Japan
| | - Robert T Jensen
- Digestive Diseases Branch, NIDDK, NIH, Bethesda, Maryland, 20817, USA
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Chebli JMF, Chebli LA, Ribeiro TCDR, Gaburri PD. Severe hypoproteinemia as a harbinger of Ménétrier's disease in autoimmune pancreatitis. Rev Assoc Med Bras (1992) 2017; 63:215-218. [PMID: 28489125 DOI: 10.1590/1806-9282.63.03.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/23/2016] [Indexed: 11/21/2022] Open
Abstract
Ménétrier's disease is an extremely rare disease of unknown etiology causing gastric mucosal hypertrophy and protein-losing gastropathy. Rare cases of this condition have been reported in patients with autoimmune diseases. However, to the best of our knowledge, Ménétrier's disease associated with autoimmune pancreatitis (AIP) has never been reported. We described a case of severe hypoproteinemia as a harbinger of Ménétrier's disease associated with AIP. The patient was successfully treated with octreotide and high-protein diet, which led to symptomatic remission and significant improvement in serum levels of albumin and recovery of the nutritional status. Thus, in AIP patients presenting with severe and persistent hypoproteinemia without apparent cause, clinicians need to consider Ménétrier's disease in the differential diagnosis. In this setting, endoscopic evaluation with histological examination of gastric biopsy material, including a full-thickness mucosal biopsy of involved mucosa, may be helpful in promptly establishing the diagnosis and allowing appropriate and timely therapy.
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Affiliation(s)
- Julio Maria Fonseca Chebli
- Gastroenterology Professor at School of Medicine of Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Liliana Andrade Chebli
- Gastroenterology Professor at School of Medicine of Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | | | - Pedro Duarte Gaburri
- Gastroenterology Professor at School of Medicine of Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
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18
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Silva PHRQD, Rigo P, Batista RP, Toma RK, Oliveira LAND, Suzuki L. Ménétrier's disease associated with gastric adenocarcinoma in a child - imaging aspect. Rev Assoc Med Bras (1992) 2017; 62:485-489. [PMID: 27849224 DOI: 10.1590/1806-9282.62.06.485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/26/2016] [Indexed: 12/16/2022] Open
Affiliation(s)
- Pedro Henrique Ramos Quintino da Silva
- Resident Radiologist, Instituto de Radiologia (INRAD), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | - Paula Rigo
- Resident Gastroenterologist, Instituto da Criança, HC-FMUSP, São Paulo, SP, Brazil
| | | | - Ricardo Katsuya Toma
- PhD in Medicine from Universidade Federal de São Paulo. Head of the Service of Gastroenterology at Instituto da Criança, HC-FMUSP, São Paulo, SP, Brazil
| | | | - Lisa Suzuki
- PhD in Medicine from FMUSP. Head of the Service of Radiology at Instituto da Criança, HC-FMUSP, São Paulo, SP, Brazil
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A Concurrent Case of Ménétrier's Disease and Signet Ring Carcinoma. ACG Case Rep J 2016; 3:e176. [PMID: 28008409 PMCID: PMC5171937 DOI: 10.14309/crj.2016.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/16/2016] [Indexed: 02/06/2023] Open
Abstract
Ménétrier's disease, also known as hyperplastic protein-losing gastropathy, is a rare, idiopathic, acquired, premalignant condition associated with gastric carcinoma. Its association with signet ring cell cancer of the stomach has been previously reported only twice. We present the third case of histologically confirmed concurrent Ménétrier's disease with signet ring carcinoma of the stomach, interrogated by esophagogastroduodenoscopy and endoscopic ultrasound.
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20
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Yao X, Hao Liang W. Cytomegalovirus and Helicobacter Pylori Co-infection in an Adult with Ménétrier's Disease: A Case Report. CHINESE MEDICAL SCIENCES JOURNAL = CHUNG-KUO I HSUEH K'O HSUEH TSA CHIH 2016; 31:129-133. [PMID: 28031103 DOI: 10.1016/s1001-9294(16)30038-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Xiang Yao
- Department of Gastroenterology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Wang Hao Liang
- Department of Gastroenterology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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21
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Heurgué-Berlot A, Féron T, Jazeron JF, Hoeffel C, Diebold MD, Cadiot G. Ménétrier's disease: Long-term remission with lanreotide. Clin Res Hepatol Gastroenterol 2016; 40:e5-9. [PMID: 26382280 DOI: 10.1016/j.clinre.2015.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 06/25/2015] [Accepted: 07/29/2015] [Indexed: 02/04/2023]
Abstract
Ménétrier's disease is a rare hypertrophic gastropathy, causing protein leak. An overexpression of transforming growth factor alpha is involved. In inhibiting the epidermal growth factor receptor, cetuximab and somatostatin analogues are the two most promising treatments, allowing to avoid radical gastrectomy. We report the case of a patient with a sustained clinical remission after treatment with lanreotide, but without complete endoscopic healing. We discuss the available therapeutic options and present a literature review of somatostatin analogues for the treatment of Ménétrier's disease.
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Affiliation(s)
| | - Thomas Féron
- CRIC U73, Hôpital Robert-Debré, 51100 Reims, France
| | - Jean-François Jazeron
- Laboratoire d'Anatomie et de Cytologie pathologiques, Centre Hospitalier de La Rochelle, 17000 La Rochelle, France
| | | | - Marie-Danièle Diebold
- Laboratoire d'Anatomie et de Cytologie pathologiques, Hôpital Robert-Debré, 51100 Reims, France
| | - Guillaume Cadiot
- Service d'Hépato-Gastro-entérologie, Hôpital Robert-Debré, 51100 Reims, France
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22
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Sheybani A, Menias CO, Luna A, Fowler KJ, Hara AK, Silva AC, Yano M, Sandrasegaran K. MRI of the stomach: a pictorial review with a focus on oncological applications and gastric motility. ACTA ACUST UNITED AC 2015; 40:907-30. [PMID: 25261256 DOI: 10.1007/s00261-014-0251-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The purpose of this pictorial review is to demonstrate gastric pathology seen on magnetic resonance imaging (MRI) and discuss the essential MRI sequences for the evaluation of benign and malignant gastric pathologies. Common tumors of the stomach, polyposis syndromes, iatrogenic conditions, as well as other conditions of the stomach will be reviewed. The utility of MRI in the evaluation of patients with gastric malignancies and disorders of gastric motility will also be discussed.
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Affiliation(s)
- Arman Sheybani
- Department of Radiology, University of Illinois Hospital and Health Sciences System, University of Illinois at Chicago, 1740 W Taylor Street, Suite 2511, Chicago, IL, 60612, USA,
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23
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Rodríguez Gonzalez O, José R, Génesis J, Luis M, Liumariel V, Raquel F, Alexis S. Robot-assisted laparoscopic gastrectomy for Menetrier's disease. J Robot Surg 2015; 9:257-61. [PMID: 26531207 DOI: 10.1007/s11701-015-0512-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/27/2015] [Indexed: 12/14/2022]
Abstract
Menetrier's disease, also known as hypoproteinemic hypertrophic gastropathy, is a rare condition characterized by the presence of gastric hypertrophy with foveolar infiltration that replaces the normal glandular architecture. We present a case of a 65-year-old female patient who had epigastric pain after meals which progressed to oral intolerance and weight loss. Upper endoscopy was performed showing prominent folds in the gastric mucosa and stenosis at the antrum-pylorus. Biopsy was taken and showed foveolar reactive hyperplasia and reactive glandular epithelium changes suggestive of Menetrier's disease. An abdominopelvic CT was performed showing a dilated stomach and gastric wall thickening. The patient was taken into the operation room for a robot-assisted total gastrectomy with esophagus-jejunum anastomosis. The patient's progress was satisfactory and he was discharged on the eighth postoperative day. Robot-assisted laparoscopic gastrectomy is a feasible and safe option that facilitates the performance of complex procedures.
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Affiliation(s)
- Omaira Rodríguez Gonzalez
- Robotic Surgery Program Medicine Faculty, Central University of Venezuela, University Hospital of Caracas, Caracas, Venezuela. .,Robotic and Minimally Invasive Surgery Center (CIMI), La Floresta Medical Institute, Caracas, Venezuela.
| | - Rosciano José
- Robotic Surgery Program Medicine Faculty, Central University of Venezuela, University Hospital of Caracas, Caracas, Venezuela
| | - Jara Génesis
- Robotic Surgery Program Medicine Faculty, Central University of Venezuela, University Hospital of Caracas, Caracas, Venezuela
| | - Medina Luis
- Robotic Surgery Program Medicine Faculty, Central University of Venezuela, University Hospital of Caracas, Caracas, Venezuela
| | - Vegas Liumariel
- Robotic Surgery Program Medicine Faculty, Central University of Venezuela, University Hospital of Caracas, Caracas, Venezuela
| | - Ferrnandez Raquel
- Robotic Surgery Program Medicine Faculty, Central University of Venezuela, University Hospital of Caracas, Caracas, Venezuela
| | - Sánchez Alexis
- Robotic Surgery Program Medicine Faculty, Central University of Venezuela, University Hospital of Caracas, Caracas, Venezuela.,Robotic and Minimally Invasive Surgery Center (CIMI), La Floresta Medical Institute, Caracas, Venezuela
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25
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Emerson JA, Adkesson MJ, Colegrove KM, Burdick SK, Langan JN. Ménétrier's disease-like hypertrophic gastritis in two red-capped mangabeys (Cercocebus torquatus). Vet Q 2014; 34:29-36. [PMID: 24625015 DOI: 10.1080/01652176.2014.894263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Chronic lymphoplasmacytic gastritis in two red-capped mangabeys (Cercocebus torquatus) at a zoological facility progressed to severe hypertrophic gastropathy similar to Ménétrier's disease that affects humans. Clinical signs included emesis, diarrhea, hunched posture consistent with abdominal pain, anemia, and hypoproteinemia. Large gastric masses were present and in one case created a gastric outflow obstruction. Both cases were positive for simian immunodeficiency virus and Helicobacter spp. were variably isolated, although the association with the hypertrophic gastropathy is unclear. Medical treatment had varying success and included sucralfate, H2 receptor antagonists, proton pump inhibitors, diet manipulations, and antibiotic therapies targeting Helicobacter spp. Surgical resection of a large portion of the stomach resulted in some palliative improvement in one case. Overall, this disease presented many challenges regarding identification, confirmation of diagnosis, and clinical management. Both aggressive medical and surgical treatments were unrewarding for long-term management of hypertrophic gastropathy in this pair of red-capped mangabeys and resulted in a poor prognosis in these cases.
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Affiliation(s)
- Jessica A Emerson
- a Department of Veterinary Clinical Sciences, College of Veterinary Medicine , University of Illinois , 2001 S. Lincoln Avenue, Urbana , IL 61802 , USA
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26
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Huang YQ, Xu JH, Han CL, Liu XY. Ménétrier's disease with refractory hypoalbuminemia: A case report. Shijie Huaren Xiaohua Zazhi 2012; 20:1160-1163. [DOI: 10.11569/wcjd.v20.i13.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Ménétrier's disease (MD) is a rare hypertrophic gastropathy characterized by giant, hyperplastic gastric mucosal folds, hyperproliferative protein-losing gastropathy, hypoalbuminemia, increased mucus secretion, and hypochlorhydria. Here we report a case of MD with refractory hypoalbuminemia in a 55-year-old female patient who presented to our hospital with anorexia, edema in the face and double lower limbs for half a year. Her serum total protein level was 39.8 g/L and her albumin level was 23.8 g/L. A CT scan revealed diffuse, uneven thickening of large gastric mucosal folds. Gastroendoscopy showed hyperplastic gastric mucosal folds in the body and fundus and profuse mucus. Microscopic examination of the biopsied specimens showed massive hyperplasia of surface and glandular mucous cells, a remarkable distortion of the foveolar, tortuosity and cystic dilatation of the glands. CT and endoscopy can help arrive at an accurate diagnosis of unexplained refractory hypoalbuminemia in patients without any gastropathy symptoms.
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27
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Dutta AK, Chiba T, Toya Y, Mizutani T, Kasugai S, Matsuda N, Shibata S, Abiko Y, Akasaka R, Yokoyama N, Oana S, Hirota S, Endo M, Uesugi N, Sugai T, Suzuki K. Unusual Manifestation of Gastric Helicobacter pylori Infection. Case Rep Gastroenterol 2012; 6:465-71. [PMID: 22855662 PMCID: PMC3398096 DOI: 10.1159/000341511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Infection with Helicobacter pylori (HP) is common in many parts of the world. While most patients are asymptomatic, it causes peptic ulcer disease and malignancy in some of them. Other rare conditions have occasionally been reported in association with this infection. We report a case of hypertrophic gastropathy caused by HP in a 52-year-old asymptomatic patient. He was found to have marked enlargement of the gastric mucosal folds on radiological imaging and endoscopy. A gastric mucosal biopsy showed HP colonization associated with neutrophilic inflammation. After exclusion of neoplasia, other infections and infiltrative disorders, HP was thought to be the cause of the gastric fold hypertrophy. The patient responded well to HP eradication therapy, with normalization of the gastric mucosal folds. HP infection should be considered in the differential diagnosis of hypertrophic gastropathy and treated accordingly.
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Affiliation(s)
- Amit K. Dutta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
- Department of Gastroenterology, Christian Medical College and Hospital, Vellore, India
| | - Toshimi Chiba
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
- *Toshimi Chiba, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate 020-8505 (Japan), Tel. +81 19 651 5111, E-Mail
| | - Yosuke Toya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Tomomi Mizutani
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Satoshi Kasugai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Nozomi Matsuda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Sho Shibata
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Yukito Abiko
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Risaburo Akasaka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Naoki Yokoyama
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Shuhei Oana
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Shigeru Hirota
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Masaki Endo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Noriyuki Uesugi
- Division of Molecular Diagnostic Pathology, Department of Pathology, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Tamotsu Sugai
- Division of Molecular Diagnostic Pathology, Department of Pathology, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Kazuyuki Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
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