Menetrier Disease

Snap Shot

• A 44-year-old male presents to his primary care physician complaining of vague abdominal pain, nausea, and vomiting. He reports that he has noticed that his shoes no longer seem to fit and wonders if he might have venous insufficiency. Hemoccult stool is positive. 

Introduction

• Hypertrophic gastropathy secondary to hyperplasia of mucus-producing cells
• Increased mucin production leads to protein loss
• Little or no acid production
  • aka hypoproteinemic hypertrophic gastropathy
• Rare acquired premalignant stomach disease
• Associated with H. pylori and CMV infections
• Caused by
  • hypoproteinemia
• Etiology unknown, but pathophysiology linked to epidermal growth factor receptor (EGFR) ligand

Presentation

• Symptoms
  • abdominal pain
  • nausea
  • emesis
  • anorexia
  • weight loss
  • occult gastric bleed
• Physical exam
  • nonspecific abdominal pain
• edema (from protein/albumin losses)

Evaluation

• Endoscopy with deep mucosal biopsy
• Gross appearance
  • giant rugal folds
• Microscopic appearance
  • atrophy of parietal cells
• Labs
  • hypoalbuminemia
• increased TGF-α

Treatment

• Medical management
  • no consensus on management
  • possible therapies have included: 
    • steroids
    • anticholinergics
    • acid suppression
    • octreotide
  • cetuximab 
    • neutralizing monoclonal antibody against EGFR
• Surgery 
  • reserved for patients with intractable symptoms or high-risk of progression to cancer
    • total gastrectomy
• subtotal gastrectomy

Prognosis, Prevention, and Complications

• ↑ risk of adenocarcinoma
• anastomotic leak and fistula is problem with subtotal gastrectomy