Menetrier's disease exacerbating ulcerative colitis and relieved by gastrectomy.

Ménétrier's disease (MD) is a rare gastropathy characterised by giant rugal folds which can present with nausea, vomiting, abdominal pain and protein losing gastropathy. We report a 21-year-old woman with comorbid MD and ulcerative colitis (UC). Management was complicated by limited treatment options for MD, significant symptom burden, worsening nutrition and difficulty determining which disease was the predominant cause of symptoms. Since age 18 the patient experienced recurrent UC flares characterised by diarrhoea, persistent vomiting and corticosteroid dependence. Endoscopic assessment demonstrated concurrent MD and active UC. Octreotide and cetuximab were trialled given persistent hypoalbuminaemia and suspicion for MD associated protein-losing gastropathy. UC management comprised dose-optimised infliximab and methotrexate. Repeat endoscopic assessment demonstrated improvement in UC without corresponding improvement in symptoms or hypoalbuminaemia. Nasojejunal feeding and parenteral nutrition failed to significantly improve nutritional status and accordingly the patient proceeded to radical total gastrectomy. Postoperatively, MD-associated symptoms and hypoalbuminemia resolved completely.

Enfermedad de Ménétrier. Presentación de un caso y revisión de la literatura / Ménétrier's disease. Case report and literature review / Doença de Ménétrier. Apresentação de caso e revisão de literatura

RESUMEN Se presentó el caso clínico de un adulto de 56 años de edad, atendido en el Servicio de Cirugía del Hospital Clínico Quirúrgico Docente "Dr. Ambrosio Grillo", provincia Santiago de Cuba, que fue operado de urgencia con el diagnóstico preoperatorio de cáncer gástrico complicado. El estudio anatomopatológico no confirmó dicho diagnóstico y sí evidenció enfermedad de Ménétrier. El paciente no presentó complicaciones en su evolución posoperatoria, por lo que se egresó 7 días después.

ABSTRACT A clinical case of a 56-year-old adult, was treated at the Surgery Service of the Teaching Surgical Clinical Hospital "Dr. Ambrosio Grillo", Santiago de Cuba province, which was operated urgently with the preoperative diagnosis of complicated gastric cancer. The pathological study did not confirm this diagnosis and did show Ménétrier disease. The patient did not present complications in his postoperative evolution, so he discharged the hospital 7 days later.

RESUMO O caso clínico de um adulto de 56 anos, atendido no Serviço de Cirurgia do Hospital Clínico Cirúrgico de Ensino "Dr. Ambrosio Grillo", província de Santiago de Cuba, operada com urgência com o diagnóstico pré-operatório de câncer gástrico complicado. O estudo patológico não confirmou esse diagnóstico e mostrou a doença de Ménétrier. O paciente não apresentou complicações em sua evolução pós-operatória e, assim, aos 7 dias ele saui do hospital.

A Rare Case of Hypertrophic Gastropathy with Adenocarcinoma Arising from a Gastric-type Adenoma.

A 60-year-old man was referred for the investigation of giant gastric folds, life-threatening anemia and hypoproteinemia. A combination of multiple endoscopic procedures derived a clinical diagnosis of protein-losing gastropathy with two gastric adenomas. After two months of alimentary therapy, the patient received total gastrectomy and fully recovered. The final pathological diagnosis was hypertrophic gastropathy of unknown origin with concomitant adenocarcinoma arising from a gastric type adenoma.

La maladie de Ménétrier en milieu hospitalier à Ouagadougou (Burkina Faso): étude de cas

La maladie de Ménétrier est une affection précancéreuse de l'estomac. Très peu d'études ont concerné cette affection dans le monde. Nous rapportons 3 cas colligés au Centre Hospitalier Universitaire Yalgado Ouédraogo. L'âge de nos malades était compris entre 51 et 73 ans avec une moyenne de 59 ans. Il s'agissait de 2 hommes et une femme de niveau socio-économique bas. Le tableau clinique était dominé par les épigastralgies, les hémorragies digestives hautes et les vomissements. La fibroscopie digestive montrait une gastropathie hypertrophique chez les trois patients avec suspicion de dégénérescence chez deux d'entre eux. L'histologie était en faveur de la maladie de Ménétrier dans tous les cas; mais elle ne confirmait la dégénérescence que chez un patient. Deux de nos patients ont bénéficié d'un traitement médical à base d'oméprazole, d'amoxicilline et de métronidazole chez l'un, clarithromycine chez l'autre. La troisième patiente a bénéficié d'une gastrectomie totale. Les suites opératoires ont été simples. La patiente s'est alimentée à base de produits liquides puis semi liquides. Les deux autres ont été perdus de vue. Ainsi, la maladie de Ménétrier reste rare et des études multicentriques pourraient permettre de dégager des protocoles de prise en charge adaptés à notre pays

Enfermedad de Menetrier como entidad poco común / Ménétrier's disease as a rare entity

La enfermedad de Menetrier se define como la poliposis gástrica múltiple. Es una entidad infrecuente y se caracteriza por pólipos hiperplásicos de menos de 2 centímetros de diámetro, que rara vez se malignizan. Se presenta una paciente con enfermedad de Menetrier, que llevó seguimiento endoscópico durante tres años y debido al aumento progresivo del número de pólipos y la sintomatología se realizó una gastrectomía subtotal sin complicaciones intra ni posoperatorias(AU)

The Ménétrier's disease is defined as multiple gastric polyposis. It is an infrequent entity characterized by hyperplastic polyps less than 2 centimeters in diameter, which rarely become malignant. We present a patient with Ménétrier's disease, who underwent endoscopic follow-up for three years and, due to the progressive increase in the number of polyps and the symptomatology, was performed a subtotal gastrectomy without intraoperative or postoperative complications(AU)

Enfermedad de Menetrier como entidad poco común / Ménétrier's disease as a rare entity

La enfermedad de Menetrier se define como la poliposis gástrica múltiple. Es una entidad infrecuente y se caracteriza por pólipos hiperplásicos de menos de 2 centímetros de diámetro, que rara vez se malignizan. Se presenta una paciente con enfermedad de Menetrier, que llevó seguimiento endoscópico durante tres años y debido al aumento progresivo del número de pólipos y la sintomatología se realizó una gastrectomía subtotal sin complicaciones intra ni posoperatorias(AU)

The Ménétrier's disease is defined as multiple gastric polyposis. It is an infrequent entity characterized by hyperplastic polyps less than 2 centimeters in diameter, which rarely become malignant. We present a patient with Ménétrier's disease, who underwent endoscopic follow-up for three years and, due to the progressive increase in the number of polyps and the symptomatology, was performed a subtotal gastrectomy without intraoperative or postoperative complications(AU)

[An infrequent cause of iron-deficiency anemia: Ménétrier disease]. / Una causa infrecuente de anemia ferropénica: Enfermedad de Ménétrier.

Ménétrier disease is a rare condition of an unknown origin, with a wide spectrum of clinical signs and symptoms at presentation. Diagnosis is made through the combination of clinical, analytical, endoscopic and histological data. Surgery is the classical treatment. However, new medical approaches have emerged.

Robot-assisted laparoscopic gastrectomy for Menetrier's disease.

Menetrier's disease, also known as hypoproteinemic hypertrophic gastropathy, is a rare condition characterized by the presence of gastric hypertrophy with foveolar infiltration that replaces the normal glandular architecture. We present a case of a 65-year-old female patient who had epigastric pain after meals which progressed to oral intolerance and weight loss. Upper endoscopy was performed showing prominent folds in the gastric mucosa and stenosis at the antrum-pylorus. Biopsy was taken and showed foveolar reactive hyperplasia and reactive glandular epithelium changes suggestive of Menetrier's disease. An abdominopelvic CT was performed showing a dilated stomach and gastric wall thickening. The patient was taken into the operation room for a robot-assisted total gastrectomy with esophagus-jejunum anastomosis. The patient's progress was satisfactory and he was discharged on the eighth postoperative day. Robot-assisted laparoscopic gastrectomy is a feasible and safe option that facilitates the performance of complex procedures.

Laparoscopic management of hypertrophic hypersecretory gastropathy with protein loss: a case report.

Hypertrophic hypersecretory gastropathy with protein loss (HHGP) is a rare form of acquired gastropathy characterized by giant gastric rugal folds and hypoalbuminemia. It is often misdiagnosed as Ménétrier's disease. We report the case of a 45-year-old man with HHGP who presented with nausea and anorexia. The patient had no underlying disease and was not on medication. Esophagogastroduodenoscopy and CT showed a thickening of the gastric folds in the stomach. As cancer cells were not detected on endoscopic biopsies, the patient was diagnosed with Ménétrier's disease. He was managed with a high-protein diet and annual follow-up by esophagogastroduodenoscopy. Five years after the diagnosis, the patient underwent laparoscopy-assisted total gastrectomy for refractory abdominal pain, diarrhea, and protein loss. A pathological diagnosis of HHGP was made and he was discharged without any surgical complications. The patient was relieved of anorexia, abdominal pain, and diarrhea. Laparoscopy-assisted total gastrectomy could be regarded as a treatment option for HHGP.

Canine giant hypertrophic gastritis treated successfully with partial gastrectomy.

A 4 yr old castrated male Jack Russell terrier was presented with a 2 mo history of vomiting, anorexia, and weight loss. Abdominal radiographs and ultrasound supported the diagnosis of gastric outflow obstruction. Celiotomy and gastrotomy revealed a large, narrowly based mass originating from the mucosa of the dorsal gastric body, occupying the lumen of the stomach and protruding through the pylorus into the duodenum. A partial gastrectomy was performed to excise the mass along with a 1 cm margin of grossly normal tissue. Giant hypertrophic gastritis was diagnosed via histopathology of the excised tissue. Giant hypertrophic gastritis is a rarely diagnosed disease of canines, characterized by giant gastric folds, hypoalbuminemia, and mucosal hypertrophy. Long-term treatment success has not been previously reported. In the case described herein, surgical excision of the affected gastric tissue provided complete resolution of clinical signs. Twelve mo following surgery, no recurrence of either vomiting or weight loss had been noted and the dog was clinically normal.

Gastric carcinoma associated with Menetrier's-like disease in a West Highland white terrier.

A seven-year-old West Highland white terrier was presented for chronic vomiting associated with mild regenerative anaemia and hypoalbuminaemia. Further examination showed a giant polypoid cerebriform mass located in the lesser curvature of the stomach. Partial gastrectomy was performed and histology was consistent with hypertrophic gastritis with typical features of Ménétrier's disease. Five years after surgery, the dog was re-examined for recurrence of vomiting episodes. Endoscopy showed ulceration of the lesser curvature of the stomach and histological analysis revealed a poorly differentiated superficial gastric carcinoma surrounded by hypertrophic gastritis. To the authors' knowledge, this is the second time that coexistence of these two types of lesions is reported, suggesting that recurrence of gastritis could be the starting point of the tumoural process.

Ménétrier's disease diagnosed by enteroclysis CT: a case report and review of the literature.

This study reports a case of Ménétrier's disease (MD) in an adult who presented with epigastric pain and peripheric edema. We focused in particular on the imaging and diagnostic aspects of the presenting case as well as clinical, histologic, and therapeutic aspects. Computed tomography (CT) enteroclysis is a new imaging technique which combines enteroclysis and spiral multislice CT. To the best of our knowledge this is the first report on a MD in an adult patient diagnosed by CT Enteroclysis.