Treatment of Ménétrier's Disease with a Monoclonal Antibody against the Epidermal Growth Factor Receptor

Burdick, J. Steven; Chung, Eun-Kyung; Tanner, Gordon; Sun, Miao; Paciga, June E.; Cheng, Jin Q.; Washington, Kay; Goldenring, James R.; Coffey, Robert J.

doi:10.1056/nejm200012073432305

Cited by 113 publications

(68 citation statements)

References 30 publications

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“…Based on clinical and research studies, it was postulated that TGF a is intimately involved in the pathogenesis of Menetrier's disease (28,34,35). Interestingly, a monoclonal antibody against EGF receptor markedly improved a Menetrier's disease patient (36). The biochemical hallmark of Menetrier's disease is gastric mucosal TGF a overexpression, suggesting that mucosal Fig.…”

Section: Discussionmentioning

confidence: 99%

Utilization of Knockout Mice to Examine the Potential Role of Gastric Histamine H2-Receptors in Menetrier's Disease

et al. 2003

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Abstract. Menetrier's disease is characterized by giant gastric folds with foveolar hyperplasia and cystic dilatation, hypoproteinemia, and enhanced mucus secretion. The etiology remains unresolved and an effective treatment has yet to be established. Here we show that histamine H 2 -receptor deficient mice developed gastric pathophysiological changes resembling Menetrier's disease for up to 17 months of observation. Mutant mice were found to have an increased stomach weight, enlarged gastric folds with cystic dilatation, hypergastrinemia, hypoalbuminemia, increased mucus secretion and overexpression of mucosal transforming growth factor (TGF) a . Both a cholecystokinin (CCK) 2 -receptor antagonist and an epidermal growth factor (EGF)-receptor tyrosine kinase inhibitor significantly reduced the increase in stomach weight. It appears that lack or downregulation of histamine H 2 -receptors might be involved in the pathogenesis of Menetrier's disease.

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Section: Discussionmentioning

confidence: 99%

Utilization of Knockout Mice to Examine the Potential Role of Gastric Histamine H2-Receptors in Menetrier's Disease

et al. 2003

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“…Patients will typically present with post‐prandial pain, vomiting and weight loss. Although benign, it carries an increased risk of low plasma protein levels, ulceration and gastric carcinoma 10 . As such, screening gastroscopy is advisable for suffers.…”

Section: Discussionmentioning

confidence: 99%

Sonographic demonstration of stomach pathology: Reviewing the cases

Deslandes¹

2013

Australas J Ultrason Med

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Introduction: The stomach can be the source of complaints for many patients attending for upper abdominal ultrasound. It is not routinely imaged as part of most upper abdominal ultrasound protocols, with sonographers and sonologists alike commonly muttering the line; “I can't see the stomach on ultrasound”. However, this is incorrect, as the gastric antrum can almost always be visualised sonographically. Discussion: It is possible to detect a range of pathologies affecting the stomach sonographically, from common, largely tolerable conditions such as hiatus hernias through to life‐threatening neoplasms. Conclusion: The stomach can easily be assessed during routine abdominal ultrasound providing the sonographer has knowledge of stomach anatomy, normal ultrasound appearances and limitations to its visualisation. While endoscopy is the gold standard for investigation of the stomach and upper gastrointestinal tract, many patients will initially present for abdominal ultrasound due to its easy, non‐invasive nature, ready availability and low cost. For patients with mild abdominal symptoms, a normal abdominal ultrasound may be the extent of their imaging investigations meaning stomach pathologies may go undiagnosed.

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“…La etiología de la enfermedad de Ménétrier se desconoce, se han postulado factores infecciosos como citomegalovirus y H. pylori que participarían principalmente en la forma infantil, habitualmente reversible en forma espontánea o secundario al tratamiento de la infección [8][9][10] . La forma adulta se ha relacionado a sobreexpresión gástrica del factor transformador de crecimiento a (TGF-a) que corresponde al ligando del receptor de factor de crecimiento epidérmico (EGFR), lo que va seguido de hiperplasia de células mucosas superficiales, aumento en la producción de mucina, atrofia de células parietales y disminución de la producción de ácido en algunos pacientes 4,11,12 . El diagnóstico de la enfermedad se basa en la sospecha clínica, la presencia en endoscopía e imágenes de pliegues gástricos engrosados y alteraciones histológicas características que incluyen hiperplasia foveolar, glándulas tortuosas y dilatadas, disminución de células parietales y leve infiltrado inflamatorio [1][2][3][4][5] .…”

Section: Discussionunclassified

“…En los casos asociados a infección por H. pylori o citomegalovirus se ha comunicado el control parcial de los síntomas luego del tratamiento de la infección. Se han utilizado tratamientos empí-ricos con antiácidos, anticolinérgicos, octreótido y prednisona, sin embargo, no existen evidencias sólidas de beneficios asociados a estas terapias 1,3,11 . La demostración del trastorno de señalización asociado a EGFR en la enfermedad de Ménétrier ha permitido el tratamiento con cetuximab, anticuerpo monoclonal que bloquea el sitio de unión de EGFR, con 7 casos comunicados en la literatura con respuesta favorable 11,12,18 .…”

Section: Discussionunclassified

“…Se han utilizado tratamientos empí-ricos con antiácidos, anticolinérgicos, octreótido y prednisona, sin embargo, no existen evidencias sólidas de beneficios asociados a estas terapias 1,3,11 . La demostración del trastorno de señalización asociado a EGFR en la enfermedad de Ménétrier ha permitido el tratamiento con cetuximab, anticuerpo monoclonal que bloquea el sitio de unión de EGFR, con 7 casos comunicados en la literatura con respuesta favorable 11,12,18 . Sin embargo, el uso de cetuximab aún es considerado como tratamiento "compasivo" por parte de la FDA, por lo que el tratamiento de elección para la enfermedad de Ménétrier continúa siendo la gastrectomía total o parcial según el compromiso gástrico presente y las características clínicas.…”

Section: Discussionunclassified

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