Ménétrier's disease with lymphocytic gastritis: An unusual association with possible pathogenic implications

Haot, J.; Bogomoletz, W. V.; Jouret, A.; Mainguet, P.

doi:10.1016/0046-8177(91)90086-5

Cited by 45 publications

(10 citation statements)

References 12 publications

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“…H. pylori infection was present in 30% to 40% in both groups. Other authors have also reported an association with lymphocytic gastritis [15][16][17]. Wolfsen et al [14••], the investigators for this 23-patient study, proposed that Menetrier's disease should only be used with reference to those patients who do not have the lymphocytic gastritis.…”

Section: Hypertrophic Gastropathiesmentioning

confidence: 88%

Emerging gastritides

Weinstein

2001

Curr Gastroenterol Rep

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The purpose of this review is to highlight two types of gastritis that have recently received much greater attention: lymphocytic gastritis and the gastritis associated with Crohn's disease. Lymphocytic gastritis is a distinctive pattern of inflammation that resembles that seen in celiac disease and lymphocytic colitis. It is associated with a diverse and unusual group of disorders in their own right, as well as having a possible relationship (real or phantom) with H. pylori infection. With respect to Crohn's disease, there is a growing recognition that, much more common than gastric granulomas, is the existence in one third or more of patients of a highly focal non-H. pylori gastritis. This recognition may help secure the diagnosis of Crohn's disease where it is equivocal, especially in children, in whom follow-up radiography and endoscopy cannot be done as readily as in adults.

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Section: Hypertrophic Gastropathiesmentioning

confidence: 88%

Emerging gastritides

Weinstein

2001

Curr Gastroenterol Rep

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“…Other features included deep lateral branching, lamina propria oedema, surface erosion and smooth muscle hyperplasia. Two distinct forms of MD have been reported in the literature—HLG and massive foveolar hyperplasia (MFH) with minimal inflammation 49 50. HLG is characterised by a large number of intraepithelial lymphocytes and highly increased inflammation in the lamina propria, whereas inflammation is not a prominent feature of MFH and intraepithelial lymphocytes are rarely seen.…”

Section: Discussionmentioning

confidence: 99%

Distinguishing Ménétrier's disease from its mimics

Rich

Toro

Tanksley

et al. 2010

Gut

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OBJECTIVE-Ménétrier's disease (MD) is a rare hypertrophic gastropathy characterised by giant rugal folds, hypochlorhydria, protein loss and a classic constellation of symptoms -nausea, vomiting, abdominal pain and peripheral oedema. It is considered a clinical diagnosis that, at times, may be difficult to establish. We propose firm diagnostic criteria for MD by delineating the clinicopathological features that best differentiate MD from its mimics. DESIGN-Forty-eight patients referred to Vanderbilt University Medical Center for consideration of enrolment in a clinical trial to treat MD patients with cetuximab were evaluated for a definitive diagnosis by assessment of clinical presentation, pertinent laboratory values and histopathological features.RESULTS-MD was confirmed in 25/48 (52%) of the patients. We designated the remaining 23 patients as mimics of MD; the most common diagnoses among the MD mimics were gastric polyps or polyposis syndromes (13/23, 57%). Gastric slides were available from 40 of 48 cases for detailed histological analysis (22/25 MD cases and 18/23 non-MD cases). Foveolar hyperplasia, glandular tortuosity and dilatation, and a marked reduction in parietal cell number were present in all 22 MD cases; lamina propria smooth muscle hyperplasia and oedema characterised most cases (18/22 and 19/22, respectively); more than half had prominent eosinophils (11/22) and/or plasma cells (12/22) in the lamina propria. The clinical presentation of MD patients was characterised by significantly younger age at onset, male predominance and increased vomiting compared to non-MD, and lower prevalence of anaemia compared to non-MD with polyps; there was trend towards increased frequency of peripheral oedema in MD versus non-MD.CONCLUSIONS-MD is most accurately diagnosed by clinicohistopathological analysis including esophagogastroduodenoscopy with gastric pH, appropriate laboratory tests (complete blood count, serum albumin, serum gastrin, H. pylori and cytomegalovirus serology) and full thickness mucosal biopsy of the involved gastric mucosa.Corresponding Author: Robert Coffey, robert.coffey@vanderbilt.edu, Tel: 615-343-6228, Fax: 615-343-1591 however, each has yielded inconsistent benefits, and none have been evaluated in a clinical trial. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] The only definitive treatment is total gastrectomy. A recently published clinical trial from our group reported that MD patients treated with cetuximab, a monoclonal antibody to the epidermal growth factor receptor (EGFR), showed significant clinical and biochemical improvement in all 7 patients that completed the one-month trial with subsequent histological reversion to normal or near normal in 4 of these patients. [27][28][29] The pathogenesis of MD is related to increased EGFR signalling in the stomach. In vitro, administration of transforming growth factor-α (TGF-α), one of seven mammalian EGFR ligands, stimulates gastric epithelial growth, inhibits acid production and increases mucin levels...

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“…Other than the so-called varioliform gastritis originally described, various endoscopic patterns can be seen, including hypertrophic gastropathy [113]. Notably, lymphocytic gastritis can be associated with prominent Menetrier-like gastropathy and protein loss reported in about 20% of the patients [114,115].…”

Section: Lymphocytic Gastritismentioning

confidence: 99%

Pathology of non-Helicobacter pylori gastritis: extending the histopathologic horizons

et al. 2009

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The development of modern endoscopic techniques, easier and greater access to healthcare, and interest in Helicobacter pylori infection and its implications have all led to a significant increase in upper endoscopies. In turn, gastroenterologists and pathologists have been recognizing an ever-increasing number of patterns of mucosal injury. Consequently, there is now an interest in a wider aspect of non-neoplastic gastric pathology, namely, non-HP (H. pylori) gastritis. In this review, we present major clinico-pathological entities, based on either the salient morphological features or the underlying etiologies.

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Ménétrier's disease with lymphocytic gastritis: An unusual association with possible pathogenic implications

Cited by 45 publications

References 12 publications

Emerging gastritides

Emerging gastritides

Distinguishing Ménétrier's disease from its mimics

Pathology of non-Helicobacter pylori gastritis: extending the histopathologic horizons

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