Diagnosis

Menetriers disease

Etiology

Cause [ftb]

• Unclear

• Probably acquired illness

• Associated with Helicobacter pylori and cytomegalovirus infection

• Theory: Overexpression of the TGF-alpha in superficial gastric epithelium

Pathophysiology [ftb]

1. Increased epidermal growth factor receptor --> increased production of TGF-alpha

2. Proliferation of epithelial cells of the mucosa:

   • Giant mucosal folds in the proximal part of the stomach

   • Abundant mucus

   • Decreased acid production

3. Hypersecretion of mucus leads to malabsorption of:

   • Nutrients

   • Electrolytes

   • Vitamins

   • Protein-losing gastropathy with hypoalbuminemia:

     • Cell damage --> Erosions, ulcerations

     • Increased mucosal permeability to proteins

4. When the rate of gastrointestinal protein loss exceeds the body's capacity to synthesize new proteins, hypoproteinemia develops

Complications [ftb]

• Malignant transformation (gastric carcinoma and gastric lymphoma)

• Thromboembolic phenomenon

• Gastric outlet obstruction

• Surgical resection --> anastomotic leak and fistula formation, bleeding

Epidemiology

Prevalence per 100.000 [ftb]

Approach

• Gastroscopy

• Biopsy

• Barium swallow

Treatment

1. The disease is self-limited in children and generally progressive in adults [ftb]

2. No pharmacological benefits proven [ftb]

3. Supportive treatment:

   • High-protein diet

   • Proton pump inhibitors

   • Replacement of micronutrients

4. Treatment of CMV and H.pylori

5. Experimental: Octreotide

6. Surgery: severe cases with intractable abdominal pain

   • Partial or total gastrectomy

Differential diagnoses

Cardiomyopathy, Coliac disease, Crohn disease, Gastric cancer, Gastric lymphoma, Gastritis, Heart failure, Histoplasmosis, Lymphocytic colitis, Mycoplasma infection, Pericarditis, Salmonellosis, Sarcoidosis, Syphilis, Tuberculosis, Ulcerative colitis, Yersinia enterocolitica, Zollinger-Ellison syndrome