Menetrier disease is a rare pathology of the stomach, which is manifested by a pronounced thickening of the gastric mucosa, a change in the glands, while the thickness of the folds exceeds 2-3 cm. The etiology of this disease has not been established. For the purpose of diagnosis, a detailed study of the patient’s complaints is carried out, the identification of hypoalbuminemia, specific signs during gastric radiography and fibrogastroscopy. Treatment consists in the use of astringent, enveloping drugs, in case of complicated forms, surgical treatment is performed. Giant hypertrophic gastritis can exist for a long time, for decades, in some cases, the pathology regresses into simple atrophic gastritis. In such cases, the prognosis is favorable.
Meaning
Menetrier disease, or giant hypertrophic gastritis, is a rare disease characterized by significant hypertrophy of the gastric mucosa, in which multiple cysts, adenomas develop (otherwise this disease is called adenopapillomatosis). This is a rare pathology, there are about 3000 cases described in the literature. It is a chronic process that is accompanied by a reduced acid-forming function of the stomach, characterized by periodic exacerbations against the background of violations of a strict diet. The low prevalence of this disease causes underdiagnosis, therefore Menetrie’s disease is attributed to pathologies in respect of which doctors should be particularly wary.
Depending on the prevailing symptom complex, there are three types of hypertrophic giant gastritis. Dyspeptic type is accompanied by predominant complaints from digestive disorders. The pseudo-tumor type is characterized by weight loss, deterioration of the general condition, weakness. The rarest variant is asymptomatic. Usually this type of disease is a godsend when performing surgical interventions or diagnostic methods for other diseases.
Causes of Menetrier disease
The causes of the disease have not been established. A certain role in its origin is assigned to errors in nutrition, low intake of vitamins into the body, chronic lead intoxication, alcoholism, certain infectious diseases, genetic, neurogenic factors. The presence of sensitization to food allergens has been proven, which causes increased permeability of the gastric mucosa.
Currently, gastroenterology considers several basic theories of the development of Menetrier disease: a consequence of inflammatory lesions of the mucous membrane, the result of abnormalities in the development of the stomach, a benign tumor process. The role of transforming growth factor alpha (TFR alpha) in the pathogenesis of the disease has been proven. It enhances the production of mucus by the stomach glands and reduces the release of hydrochloric acid.
Menetrier disease symptoms
Clinical symptoms of the disease develop gradually. The most common sign is pain in the epigastric region. Pain syndrome can have different duration and severity, more often the pain is aching, occurs after eating and is combined with a feeling of heaviness in the stomach. Vomiting, diarrhea, and stomach bleeding are possible.
An important diagnostic sign is a decrease in body weight. In a fairly short period of time, the patient can lose up to 10-20 kilograms without changing eating habits. In rare cases, there is a decrease in appetite. There may be peripheral edema, which is caused by a decrease in the content of proteins in the blood serum.
A number of specialists define Menetrie’s disease as a precancerous disease, taking into account the frequency of gastric adenocarcinoma against the background of hypertrophic gastritis, which reaches 10-20%. But other gastroenterologists question these data, because in many studies devoted to this disease, histological confirmation of cause-and-effect relationships of adenopapillomatosis and stomach cancer has not been proven.
Pathology can exist for a long time, proceeding with periodic exacerbations and long-term remissions. In some cases, there is a decrease in symptoms and the transition of the disease into an atrophic form of gastritis (atrophic gastritis).
Diagnostics
Diagnosis begins with a detailed study of the patient’s complaints in dynamics. Since the disease can be asymptomatic for a long time, it is important to find out the slightest changes in well-being, weight, nutrition.
In blood tests, a decrease in the number of red blood cells, hemoglobin is determined. This is due to frequent blood loss, but anemia is rarely pronounced. In some cases, leukocytosis with neutrophil shift is noted. Biochemical blood tests reveal a decrease in albumin levels. This is due to the fact that proteins are lost due to increased permeability of the mucosa. This fact has been confirmed by studies using intravenous labeled albumin. When determining the acidity of gastric juice, a hypoacid state is noted.
An important diagnostic method for adenopapillomatosis is stomach radiography, which reveals characteristic signs: pronounced thickening of the folds of the gastric mucosa locally or over the entire area. When contrasting the stomach with a tight filling with a contrast mixture, greatly enlarged folds can give a picture of a filling defect characteristic of oncological pathology. But with hypertrophic gastritis, there is no breakage of the folds, they have a certain location. At the same time, the walls of the stomach retain elasticity, sufficient peristalsis is determined by both curvatures. With further filling of the stomach with contrast, the folds are straightened, which makes it possible to distinguish this pathology from stomach cancer.
A characteristic picture of the altered mucosa can be revealed by endoscopic examination – fibrogastroscopy. When examining the mucosa with the help of fiber optics, a significant thickening of the folds, which take the form of a “cobblestone pavement”, their puffiness, pallor, less often – hyperemia, is determined. The mucosa is easily vulnerable, there are often erosions in the upper parts of the folds. The folds are mostly arranged in parallel, less often chaotically. Their height is more than two centimeters. Rarely, the total number of folds can be increased, in most cases it remains within the normal range. During the EGDS, inflating with air is used, while the folds that do not straighten out when the pressure reaches 15 mm Hg are considered gigantic.
The targeted biopsy is carried out for the purpose of differential diagnosis with malignant neoplasms. The histological picture characteristic of Menetrier disease is not detected with this type of biopsy, since the altered glands do not fall into the surface material taken.
To identify their changes, a biopsy of deep areas of the mucosa is performed with the capture of the layers in which the glands are located. This allows you to confirm the disease histologically. However, the diagnostic errors of such a biopsy are higher, since taking the material “blindly” (without endoscopic control) does not always allow you to take the material from the changed site. Due to the complexity of histological confirmation, the diagnosis can be established by observing the patient in dynamics, as well as repeated X-ray diagnostics and endoscopy.
Treatment for Menetrier disease
The treatment of this pathology is carried out by a gastroenterologist. It is mandatory to follow a sparing diet enriched with protein. Dishes should be prepared taking into account their thermal, chemical and mechanical neutrality for the mucous membrane. Spicy, fried dishes are not recommended, as well as eating too hot or cold.
Mild forms involve conservative therapy. Enveloping, astringent drugs that protect the gastric mucosa are prescribed. If necessary, the deficiency of acid-forming function is replaced. The use of anticholinergic agents (atropine) contributes to the reduction of protein loss, as well as to the subjective improvement of well-being.
In the severe course of giant hypertrophic gastritis, accompanied by a pronounced persistent pain syndrome, frequent bleeding, the development of edema due to protein deficiency, surgical treatment is performed – gastrectomy. This method is also applicable in situations where it is not possible to exclude a malignant neoplasm. Patients with this diagnosis are subject to dispensary supervision, control radiography and EGD are carried out every six months. This allows you to correctly assess the dynamics of the disease.
Prognosis and prevention
The course of this disease may be different. Most often, symptoms have existed for many years, but regression into atrophy with the restoration of serum albumin levels is possible. The fact of the association of adenopapillomatosis with gastric adenocarcinoma has not been proven. In uncomplicated forms, the course of the disease largely depends on diet, and not only during exacerbations, regular examinations for the purpose of timely detection of complications. Since the etiological factor of this pathology has not been established, there is no specific prevention.
Literature
- Total gastrectomy for the treatment of Menetrier’s disease persistent to medical therapy: A case report. Parianos C, Aggeli C, Sourla A, Zografos GN. Int J Surg Case Rep. 2020;73:95-99. link
- Ménétrier’s Disease and Its Atypical Presentation in Four Siblings. Hassan IH, Soliman M, Shirazi-Nejad AR. Cureus. 2022 Oct 27;14(10):e30759. link
- Co-Infection with Cytomegalovirus and Helicobacter pylori in a Child with Ménétrier’s Disease. Yoo Y, Lee Y, Lee YM, Choe YH. Pediatr Gastroenterol Hepatol Nutr. 2013 Jun;16(2):123-6. link
- Ménétrier’s disease of the stomach: a clinical challenge. Lambrecht NW. Curr Gastroenterol Rep. 2011 Dec;13(6):513-7. link
- Possible role of transforming growth factor alpha in the pathogenesis of Ménétrier’s disease: supportive evidence form humans and transgenic mice. Dempsey PJ, Goldenring JR, Soroka CJ, Modlin IM, McClure RW, Lind CD, Ahlquist DA, Pittelkow MR, Lee DC, Sandgren EP, et al. Gastroenterology. 1992 Dec;103(6):1950-63. link