Makindo Medical Notes

🌿 Ménétrier Disease (giant hypertrophic gastritis / hyperplastic hypersecretory gastropathy) is a rare, acquired premalignant condition. It is characterised by hypertrophied gastric folds due to mucous cell hyperplasia, protein-losing gastropathy, and hypochlorhydria. About 15% of cases progress to gastric cancer, highlighting the need for vigilance.

📖 About

• Acquired, rare gastric disorder with hypertrophic rugal folds.
• Premalignant: ~15% develop gastric adenocarcinoma.
• Most often affects middle-aged to older adults; male predominance.

⚠️ Aetiology & Pathogenesis

• 📌 Rugal fold hypertrophy due to foveolar hyperplasia (mucus-secreting cells).
• ⬇️ Hypochlorhydria (reduced gastric acid) from glandular atrophy.
• 💧 Protein-losing enteropathy → hypoalbuminaemia + oedema.
• 🔬 Excess secretion of TGF-α, activating EGFR pathways → mucosal proliferation.
• 🦠 Possible associations: Helicobacter pylori and CMV (especially in children).

🩺 Clinical Features

• Upper abdominal pain / epigastric discomfort.
• Nausea and vomiting.
• Peripheral oedema (ankles/legs) from protein loss.
• Unintentional weight loss + anorexia.
• Anaemia from chronic GI bleeding.
• Fatigue, malaise, early satiety due to thickened gastric folds.

🔍 Investigations

• Endoscopy: Enlarged, thickened gastric folds (classically in fundus and body; sparing antrum).
• Biopsy: Foveolar hyperplasia, glandular atrophy, cystic dilatation of glands.
• CT / Barium study: Demonstrates giant gastric folds.
• Blood tests: Hypoalbuminaemia, anaemia, hypoproteinaemia.

🛠️ Management

• Medical:
  • PPIs → reduce acid output and help symptoms.
  • Octreotide → somatostatin analogue reducing protein loss.
  • EGFR inhibitors (e.g., cetuximab) in experimental/selected cases.
• Nutritional support: High-protein diet, albumin infusion if severe hypoalbuminaemia.
• Plasmapheresis: Removes circulating growth factors (rarely used).
• Surgery: Subtotal or total gastrectomy for refractory disease, severe protein loss, or high malignant risk.

📊 Prognosis

• Variable; some cases remit spontaneously (especially in children with CMV-associated form).
• Adults have chronic course with risk of gastric carcinoma (~15%).
• Requires endoscopic surveillance in adults.

📚 Teaching Commentary

💡 Think of Ménétrier Disease as the opposite of Zollinger-Ellison syndrome: – Ménétrier = low acid, high mucus, protein loss. – Zollinger-Ellison = high acid, peptic ulcers, hypergastrinaemia.

🩺 In the UK, rare but important to recognise because of its link to gastric cancer. If you see giant rugal folds + hypoalbuminaemia, always consider Ménétrier Disease in your differential.

📖 References

• NIDDK – Ménétrier’s Disease