Clinical and morphological studies of giant hypertrophic gastritis (Ménétrier's disease)

Hypertrophic gastritis with hypergastrinemia and protein loss after neonatal thymectomy in mice

Hypertrophic gastritis, histologically characterized by a depletion of parietal and chief cells and by varying degrees of lymphocyte infiltration along the thickened muscularis mucosa, could be induced by neonatal thymectomy (Tx) without any additional treatment in about 50% of mice (C3H/HeMs X 129/J)F1 (C3.129). The thickness of the mucosa in gastritic mice increased with age, forming giant folds. In Tx mice with an early stage of abnormal mucosal folds at 6 months of age, numbers of parietal cells per mucosal tissue unit area (parietal cell densities) and ratios of parietal cells to mucous cells became lower than in control mice, and serum gastrin levels became contrastingly higher with the increasing severity of gastritis. Circulating antibodies against parietal cells (APA) were detected by indirect immunofluorescence (IFL) in the mice. A good correlation was observed between APA and gastritis: APA with high titers (more than 1,000-fold dilutions) appeared when severe lesions were found. In mice with giant mucosal folds at 18 months of age, serum protein levels were within normal limits, but fecal clearance rates of 125I-labelled polyvinylpyrrolidone (125I-PVP) were significantly increased. These results suggest that the hypertrophic gastritis induced by neonatal Tx is characterized by hypergastrinemia due to parietal cell depletion caused by the presence of circulating APA and the protein loss from the hypertrophic mucosa. Both histological and physiopathological similarities were found between the gastritis in the mice and Menetrier's disease in man.

Pancreatic insufficiency and Ménétrier's disease. Report of a case with clinical response to pancreatic enzyme replacement

A patient with exocrine pancreatic insufficiency and hypoalbuminemic edema was shown also to have a protein-losing gastropathy secondary to giant hypertrophic gastritis (Ménétrier's disease). Despite continuation of excessive gastric protein loss, the manifestations of hypoproteinemia were reversed by oral pancreatic enzyme replacement therapy. We speculate that impaired intraluminal proteolysis exaggerated the consequences of gastric protein loss.

The natural history of hypertrophic gastrophy (Menetrier's disease). Report of a case with 16 year follow-up and review of 120 cases from the literature

We describe a 33 year old man who presented with epigastric pain, weight loss and hematemesis. Roentgenograms of the upper gastrointestinal tract and endoscopy demonstrated giant rugal folds, and the diagnosis of hypertrophic gastropathy was confirmed by operative biopsy. This patient's symptoms and abnormalities noted on the roentgenograms persisted until his death 16 years later. Postmortem examination confirmed the persistence of hypertrophic gastropathy and revealed, in addition, a hepatocellular carcinoma metastatic to the stomach and regional lymph nodes. A review of 120 previously reported cases of hypertrophic gastropathy with special attention to its natural history indicates that the chronic nature of this patient's illness is typical. In addition, the chance of gastric carcinoma developing in these patients is appreciable. Since the reported long-term results of operative therapy appear favorable, patients with persistent and sufficiently distressing symptoms should be considered for gastric resection.

Cronkhite-Canada syndrome. Case report

The case report of a 72-year-old man with the characteristic clinical and pathologic-anatomic picture of the Cronkhite-Canada syndrome is presented. The clinical features and the radiographic appearance of the gastrointestinal tract suggested Ménétrier's disease. Subtotal gastrectomy was performed and at the subsequent pathologic-anatomic examination, the diagnosis of Cronkhite-Canada syndrome was made. The patient slowly recovered over the following five months while being treated with the so-called astronaut diet (Vivasorb) supplemented with vitamins, iron and electrolytes. He died five months after surgery from intercurrent disease. The differential diagnosis of gastrointestinal polyposis with or without mucocutaneous pigmentation is briefly discussed. The histochemical characteristics of the epithelium in the gastric and colonic polyps was studied in some detail. The authors believe that the gastrointestinal polyps in the Cronkhite-Canada syndrome are regenerative and non-neoplastic in nature.

Surgical management of Menetrier's disease with protein-losing gastropathy

Three patients with Menetrier's disease and protein-losing gastropathy who were studied during a 12 year period have been presented. The characteristic findings which differentiate them from patients with hypertrophic hypersecretory gastropathy, including the Zollinger-Ellison syndrome, are: 1) hypertrophy of gastric mucosa with giant rugal folds involving the fundus, cardia and body of the stomach but sparing the antrum; 2) muscosal hypertrophy consisting of gastric mjcus-secreting cells while parietal cells and chief cells are diminished in number and may be absent from many microscopic sections; 3) gastric secretion of large volume containing excess mucus, low to absent hydrochloric acid and protein concentration 5 or 6 times normal (1.7 mg/ml); 4) hypoalbuminemia and hypoglobulinemia due to loss of serum proteins fron gastric mucosa into the gastric lumen; 5) rare association with gastric ulcer. Unlike the Zollinger-Ellison syndrome none of our patients had duodenal ucler or multiple endocrine adenomatosis or a family history of these conditions. We have found no authenticated reports in the literature which document a relationship of Menetrier's disease ( as defined above) with multiple endocrine adenomatosis. Menetrier's disease with protein-losing gastropathy is a potentially lethal disorder of unknown cause with no specific treatment. Resection of the site of gastric protein losses as first done by Waugh is logical and effective. One of our three patients died in hospital before gastrectomy was done. Two others have done well for 11 months and 12 years, respectively, after total gastrectomy with Roux-en-Y esophagojejunostomy and Hunt-Lawrence jejunal pouch.