Diffuse hypertrophy of gastric mucosa (Menetrier's disease) and iron-deficiency anaemia

Abstract

SUMMARY A 23-year-old woman presented with intractable iron-deficiency anaemia. A barium meal showed widespread mucosal abnormalities in the stomach and massive mucosal hypertrophy was found at laparotomy. Repeated tests for occult blood were negative but gastrointestinal haemorrhage was confirmed by isotopic blood labelling. In the face of persistent anaemia and radiological progression, total gastrectomy was performed, since when a normal blood picture has been maintained. The excised stomach showed hyperplasia of all the mucosal elements, minimal inflammation, and no obvious bleeding point. Blood loss was attributed to diapedesis from a greatly increased capillary network.

Natural history of adult-onset Ménétrier's disease: Report of a case with 9-year follow-up

“…In addition, previous cases of MD have also presented with severe iron-deficiency anemia (14,15). In the present case, anemia and hypoproteinemia were successfully eliminated by red cell transfusion and intravenous iron therapies.…”

Iron Deficiency and Thrombocytosis-Reply

“…5 It may, therefore, be concluded that the thrombocytosis detected in the case presented is far from being a mystery and is merely the result of the interplay of two factors, namely, chronic rectal bleeding and oral iron therapy. After the initiation of therapy, platelets start to rise on the third or fourth day, reaching some¬ times higher than normal levels or, at least, attain the upper limit of nor¬ mal, and return sometime within a month to completely normal quan¬ tities even in patients with hypersplenism.…”

The diagnosis of Ménétrier’s disease

“…It has been said to be due to prolapsing of the mucosa through the pylorus. In 4 previously reported cases, severe haematemesis was the indication for emergency surgery (Dickinson and Axon, 1979;Singh et al, 1979). Occult bleeding is more common and, in T.S.…”

“…The condition was first described by Menetrier in 1888 and since then some 200 cases have been reported in the literature. These reports have concerned the pathology (Butz, 1960), the protein turnover (Jarnum and Jensen, 1972;Jones et al, 1972), the gastric protein loss (Citrin, Sterling and Halstead, 1957) and case reports of the various types of presentation, notably acute gastrointestinal (GI) bleeding (Williams, 1956), chronic GI bleeding (Singh, Cumaraswamy and Corrin, 1979), and oedema (Chokas, Connor and Innis, 1959). Diarrhoea has occasionally been reported.…”