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Hypertrophic gastropathy--that is, Ménétrier's disease--was found, in a retrospective analysis, to be associated with Helicobacter pylori in more than 90% of patients. It is proposed that hypertrophic gastropathy represents a special form of H pylori gastritis in these patients. A case is described of a 28 year old woman with Ménétrier's disease associated with proved protein loss from the stomach. Treatment with cimetidine for more than three years had little benefit when colonisation by H pylori was detected. Density of H pylori colonisation and activity of gastritis, which was also present in the first biopsy specimens taken five years ago, were more pronounced in the body than in the antrum, which is in agreement with the characteristics of H pylori gastritis found in other cases with Ménétrier's disease. A 14 day antibacterial treatment course with 750 mg amoxicillin three times a day combined with 40 mg omeprazole three times a day was started in April 1991. This resulted in eradication of H pylori and the return to normal of giant folds and the mucosal histology. Serum protein concentrations returned to normal within six weeks and remained normal at two endoscopies during a two year follow up. This case report suggests that a subgroup of the patients with Ménétrier's disease may be healed by the eradication of H pylori.

Ménétrier’s disease is a rare protein-losing hypertrophic gastroenteropathy. While it still remains a medical curiosity, infection with Cytomegalovirus and Helicobacter pylori, and hormonal, congenital, dietary and neurogenic factors have been postulated as causative factors. We describe a case of a 14-year boy who presented with epigastric discomfort, vomiting, inability to gain weight and pedal oedema. Investigations revealed hypoproteinaemia without proteinuria and elevated faecal α-1-antitrypsin levels suggestive of protein-losing enteropathy. Imaging and endoscopic features demonstrated cerebriform gastric folds indicative of Ménétrier’s disease. Infective, hormonal and neurogenic causes were ruled out in our patient. Surprisingly, the patient had a history of pica and an associated large gastric bezoar, which was ultimately removed surgically. An association of Ménétrier’s disease with a bezoar has been reported only once previously. We thus add to the existing literature and highlight the plausible role of a bezoar as a causative factor in the pathogenesis of Ménétrier’s disease due to its irritant nature.

The broad clinical heterogeneity of Menetrier's disease (MD) has been recently described by Rich et al .1 There are few reports on MD patients with a history of ulcerative colitis (UC). Overexpression of the transforming growth factor α (TGFα) leads to gastric epithelium abnormalities similar to those of MD.2 A significant increase in TGFα levels has been observed in inactive UC compared with healthy controls. TGFα could be the link between both inactive UC and the development of MD. TGFα stimulates gastric cell proliferation as well as mucin biosynthesis. Normal gastric mucosa expresses MUC1 and MUC5Ac in foveolar epithelium and MUC6 in the glands, while MUC2 and MUC3 are predominantly expressed in goblet cells and enterocytes, respectively, of the small intestine. We investigated mucin expression in a …

Ménétriers disease is a rare mucosal hyperproliferative disorder of the stomach, however, the evidence for long-term care remains limited, especially if a gastrectomy is declined. We present a case of 25-year-old Caucasian woman with a history of end-stage renal failure (ESRF) who experienced worsening symptoms of abdominal pain, haematemesis and abdominal swelling, with her serum albumin dropping to 20 g/L and haemoglobin to 4.9 g/dL. Endoscopy showed markedly hyperplastic gastric folds consistent with Ménétriers disease, confirmed histologically by gland dilation and gastric pit expansion. Intravenous cetuximab was prescribed for 12 months, with clinical, biochemical and endoscopic improvement. However, 5 weeks post cetuximab completion, there was relapse to 50% gastric coverage with Ménétriers. A discussion around gastrectomy was rejected by the patient. This is the first report of relapsing Ménétriers disease in a female patient with ESRF; we suggest that long-term cetuximab should be considered if a gastrectomy is declined.

A 48-year-old man presented with haematemesis and was found to have Menetrier's disease. Three and a half years later early gastric cancer was detected at routine follow-up endoscopy. This is the first report of the development of early gastric cancer during follow-up in a case of Menetrier's disease. It is probable that patients with Menetrier's disease are at increased risk of gastric cancer, and should have regular endoscopic follow-up with gastric biopsy.

Familial giant hypertrophic gastritis involving three generations is reported. A review of the literature, where approximately 200 cases are described, showed only few cases of familial occurrence of this disease, and only in siblings. Our findings suggest dominant heredity, but considering the sparsity of familial occurrence reported earlier, heredity seems to be of only minor pathogenetic significance.

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.