Ménétrier’s disease (MD), which is characterized by hypertrophic gastric folds and foveolar cell hyperplasia, is the most common gastrointestinal (GI) cause of protein-losing enteropathy (PLE). The clinical course of MD in childhood differs from that in adults and has often been reported to be associated with cytomegalovirus (CMV) infection. We present a case of a previously healthy 22-month-old boy presenting with PLE, who was initially suspected to have an eosinophilic GI disorder. However, he was eventually confirmed, by detection of CMV DNA using polymerase chain reaction (PCR) with gastric tissue, to have MD associated with an active CMV infection. We suggest that endoscopic and pathological evaluation is necessary for the differential diagnosis of MD. In addition, CMV DNA detection using PCR analysis of biopsy tissue is recommended to confirm the etiologic agent of MD regardless of the patient’s age or immune status.
Adult ; Biopsy ; Child ; Cytomegalovirus Infections ; Cytomegalovirus ; Diagnosis, Differential ; DNA ; Eosinophils ; Gastritis, Hypertrophic ; Humans ; Hyperplasia ; Infant ; Male ; Polymerase Chain Reaction ; Protein-Losing Enteropathies

Menetrier's disease is a rare protein-losing hypertrophic gastropathy. Histologically, it can be mistaken for other disorders showing hypertrophic gastropathy. The pathogenesis of Menetrier's disease is not fully understood; however, it appears that the epidermal growth factor receptor (EGFR) ligand, transforming growth factor alpha, contributes to the pathogenesis of this disorder. In this review, we will discuss disease entities that can mimic Menetrier's disease and the role of EGFR signaling in Menetrier's disease.
Gastritis, Hypertrophic* ; Receptor, Epidermal Growth Factor ; Transforming Growth Factor alpha

Gastritis, Hypertrophic ; Humans

BACKGROUND/AIMS: Endoscopic classification of chronic gastritis has not been standardized yet. Patterns of endoscopic classification in the real clinical practice are not defined. MATERIALS AND METHODS: From July 2013 to September 2013, a questionnaire consisting of eight questions on endoscopic gastritis was surveyed. The correct answer for endoscopic diagnosis of chronic gastritis was defined by an advisory group, including professors of gastroenterology. A total of 189 physicians, most of them primary care physicians, participated in the survey. RESULTS: The overall agreement with standard endoscopic diagnoses was 56 percent. The correct answer for each question was 56 percent for erosive gastritis, 58 percent for hypertrophic gastritis, 60 percent for atrophic gastritis, 52 percent for metaplastic gastritis, respectively. In the superficial gastritis case, the ratio of correct answer was 24 percent, which was lowest among all the questions. Forty-four percent of all participants answered superficial gastritis as hemorrhagic gastritis. These results reveal that hemorrhagic gastritis is diagnosed inappropriately and needs further attention to prevent patients from unnecessary worries and misunderstandings. The correct answer for nodular gastritis was 42 percent, which is relatively low as well. Considering the significance of nodular gastritis as a risk factor for gastric cancer, education for endoscopist to detect nodular gastritis is indispensable. CONCLUSIONS: There was significant discrepancy on the endoscopic diagnosis of chronic gastritis. Further studies to develop a new standardized guideline for diagnosis of gastritis should be accompanied.
Classification ; Diagnosis* ; Education ; Endoscopy ; Gastritis* ; Gastritis, Atrophic ; Gastritis, Hypertrophic ; Gastroenterology ; Humans ; Physicians, Primary Care ; Risk Factors ; Stomach Neoplasms ; Surveys and Questionnaires

Menetrier's disease in childhood is a rare form of gastropathy characterized by hypoalbuminemia, endoscopic and/or radiologic findings of hypertrophic gastric folds, and histologic findings of foveolar hyperplasia in the stomach. It tends to have a self-limited course compared to the chronic and complicated course in adult Menetrier's disease. A 7-year-old boy was referred to Incheon St. Mary's Hospital for facial edema. Physical examination on admission showed periorbital swelling, pitting edema in both legs, and epigastric tenderness. Laboratory tests on admission indicated hypoproteinemia (3.0 g/dL) with hypoalbuminemia (2.1 g/dL) and hypogammaglobulinemia. Urinalysis showed no abnormalities. The test results for anti-cytomegalovirus immunoglobulin M and cytomegalovirus PCR were negative. Stool Helicobacter pylori antigen was positive and fecal alpha1-antitrypsin clearance was 40.1 mL/day, consistent with protein-losing gastroenteropathy. Gastroduodenoscopy showed hypertrophic edematous gastric folds, erythema, and superficial erosion in the body of the stomach. The duodenum was normal. Histologic findings showed foveolar hyperplasia. His symptoms improved with conservative treatment including proton pump inhibitor from day 9 of hospitalization and resolved completely. Here we reported a case of pediatric protein-losing hypertrophic gastropathy associated with Helicobacter pylori infection.
Adult ; Agammaglobulinemia ; Child ; Cytomegalovirus ; Duodenum ; Edema ; Erythema ; Gastritis, Hypertrophic* ; Helicobacter pylori* ; Hospitalization ; Humans ; Hyperplasia ; Hypoalbuminemia ; Hypoproteinemia ; Immunoglobulin M ; Incheon ; Leg ; Male ; Physical Examination ; Polymerase Chain Reaction ; Proton Pumps ; Stomach ; Urinalysis

Menetrier's disease is a rare protein-losing gastropathy characterized by hypertrophic gastric fold, foveolar hyperplasia, and hypoproteinemia with resulting peripheral edema. It is clinically evident as nonspecific gastrointestinal symptoms, including abdominal discomfort, nausea and vomiting, abdominal pain, weight loss, diarrhea, and edema. Pediatric Menetrier's disease usually has an insidious onset and progressive, chronic clinical course and it spontaneously resolves in weeks or months. The pathogenesis of Menetrier's disease is not clearly understood. Menetrier's disease is thought to be associated with some gastric infections. But the cause of Menetrier's disease is unknown, an association with cytomegalovirus (CMV) and Helicobacter pylori has been suggested. In Korea, We present the first a case of pediatric Menetrier's disease with positive evidence of CMV and H. pylori.
Abdominal Pain ; Child ; Coinfection ; Cytomegalovirus ; Diarrhea ; Edema ; Gastritis, Hypertrophic ; Helicobacter ; Helicobacter pylori ; Humans ; Hyperplasia ; Hypoproteinemia ; Korea ; Nausea ; Vomiting ; Weight Loss

Menetrier's disease is a rare form of acquired gastropathy characterized by giant rugal folds in the stomach and protein-losing gastropathy. Children with Menetrier's disease tend to follow a benign self-limited course with symptoms typically completely resolving within 2 to 10 weeks in contrast to the chronic course in adults. A 9-year-old girl presented with a history of gradually worsening abdominal distension, increasing body weight, and abdominal pain for 2 weeks. Physical examination on admission indicated periorbital swelling, pitting edema in both the legs, and abdominal distension with mild diffuse tenderness and shifting dullness. Laboratory tests on admission showed hypoalbuminemia, hypoproteinemia, and peripheral eosinophilia. The test result for anticytomegalovirus immunoglobulin M was negative. Increased fecal alpha 1 anti-trypsin excretion was observed. Radiological findings showed massive ascites and pleural effusion in both the lungs. On gastroscopy, large gastric folds, erythema, erosion, and exudation were noted in the body and fundus of the stomach. Microscopic findings showed infiltration of eosinophils and neutrophils in the gastric mucosa. Her symptoms improved with conservative treatment from day 7 of hospitalization and resolved completely.
Abdominal Pain ; Adult ; Ascites ; Body Weight ; Child ; Cytomegalovirus ; Edema ; Eosinophilia ; Eosinophils ; Erythema ; Gastric Mucosa ; Gastritis, Hypertrophic ; Gastroscopy ; Hospitalization ; Humans ; Hypoalbuminemia ; Hypoproteinemia ; Immunoglobulin M ; Leg ; Lung ; Neutrophils ; Physical Examination ; Pleural Effusion ; Protein-Losing Enteropathies ; Stomach

No abstract available.
Endosonography ; Gastric Mucosa/pathology ; Gastritis, Hypertrophic/*diagnosis/pathology/surgery ; Gastroscopy ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed

Menetrier's disease is a rare entity characterized by large, tortuous gastric mucosal folds. The mucosal folds in Menetrier's disease are often most prominent in the body and fundus. Histologically, massive foveolar hyperplasia (hyperplasia of surface and glandular mucous cells) is noted, which replaces most of the chief and parietal cells. Profuse mucus is usually observed during the endoscopy but there have been few cases that show interesting endoscopic findings such as mucus bridge or water pearl. Herein, we report a case of Menetrier's disease showing mucus bridge by excessive mucus observed during the endoscopy.
2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use ; Amoxicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Clarithromycin/therapeutic use ; Drug Therapy, Combination ; Gastric Mucosa/*pathology/secretion ; Gastritis, Hypertrophic/*diagnosis/pathology ; Gastroscopy ; Helicobacter Infections/diagnosis/drug therapy ; Helicobacter pylori ; Humans ; Male ; Middle Aged ; Mucus/secretion ; Proton Pump Inhibitors/therapeutic use ; Tomography, X-Ray Computed

Menetrier's disease is a protein-losing hypertrophic gastropathy characterized by diffuse tremendous thickening of the gastric wall caused by excessive proliferation of the mucosa. Although the cause of Menetrier's disease is unknown, an association with Helicobacter pylori has been reported. A 42-year-old man was hospitalized for the evaluation of progressive body weight loss and indigestion for 6 months, with recently aggravated epigastric discomfort. Gastroscopy revealed prominent mucosal folds in the body and fundus. The histological findings revealed gastritis with erosions and foveolar hyperplasia. After eradicating the Helicobacter pylori and treatment with a proton pump inhibitor, clinical and endoscopic resolution ensued.
Adult ; Body Weight ; Dyspepsia ; Gastritis ; Gastritis, Hypertrophic ; Gastroscopy ; Helicobacter ; Helicobacter pylori ; Humans ; Hyperplasia ; Mucous Membrane ; Proton Pumps ; Protons