Menetrier Disease Causes, Symptoms, Diagnosis, Treatment

Menetrier Disease Causes, Symptoms, Diagnosis, Treatment


GENERAL DISCUSSION


Menetrier disease is a rare disorder characterized by massive overgrowth of mucous cells (foveola) in the mucous membrane lining the stomach, resulting in large gastric folds. The main symptom associated with Menetrier disease is pain in the upper middle region of the stomach (epigastric pain). The cause of Menetrier disease is unknown. 

There is considerable confusion and contradiction in the medical literature regarding disorders involving large gastric folds. The name Menetrier disease is often erroneously used to describe any condition with large gastric folds or as a synonym for giant hypertrophic gastritis (GHG). However, Menetrier disease is not a true form of gastritis. A diagnosis of Menetrier disease should be reserved for individuals with large gastric folds due to overgrowth of mucous cells. There is minimal or no stomach inflammation in Menetrier disease. Because inflammation is minimal or not present, Menetrier disease is classified as a form of hyperplastic gastropathy and not as a form of gastritis. Some researchers believe that Menetrier disease and GHG may be variants of the same disorder or different parts of one disease spectrum.

What is Menetrier Disease?


Menetrier Disease causes the ridges along the inside of the stomach wall—called rugae—to enlarge, forming giant folds in the lining of the stomach. The rugae enlarge because of an overgrowth of surface mucous cells of the stomach. In a normal stomach, rugae release protein-containing mucus. Enlarged rugae release too much mucus, causing a leakage of protein from the blood into the stomach. This shortage of protein in the blood is known as hypoproteinemia. Menetrier Disease also causes a decrease in stomach acid resulting from a reduction in acid-producing parietal cells.

People with Menetrier Disease suffer from severe stomach pain, nausea, frequent vomiting, and other symptoms. They also have a higher risk of developing stomach cancer, also called gastric cancer.
Menetrier Disease is also called hypoproteinemic hypertrophic gastropathy.

Other conditions that can cause enlarged rugae but are not Menetrier Disease include
  • Zollinger-Ellison syndrome—a condition in which tumors in the pancreas cause the stomach to make too much acid
  • syphilis—a type of sexually transmitted bacterial infection
  • cytomegalovirus—a type of viral infection
  • histoplasmosis—a type of fungal infection
  • linitis plastica—a type of gastric cancer
  • gastric lymphoma—a type of cancer originating in the stomach


What causes Menetrier Disease?


What causes Menetrier Disease is unclear; however, it is thought to be an acquired disorder with no known genetic component. Recent studies suggest people with Menetrier Disease have stomachs that make abnormally high amounts of a protein called transforming growth factor-alpha (TGF-α). Growth factors are proteins in the body that tell cells what to do, such as grow larger, change shape, or divide to make more cells. A cause for the overproduction of TGF-α has yet to be found.

What are the symptoms of Menetrier Disease?


  • Possible signs and symptoms of Menetrier Disease include
  • severe pain in the top middle part of the abdomen
  • nausea and frequent vomiting
  • swelling of the face, abdomen, limbs, and feet
  • loss of appetite
  • extreme weight loss
  • malnutrition
  • low blood protein
  • anemia
  • diarrhea

How is Menetrier Disease diagnosed?


Menetrier Disease is diagnosed through x rays, endoscopy, and biopsy of stomach tissue. Endoscopy involves looking at the inside of the stomach using a long, lighted tube inserted through the mouth. During a biopsy, the doctor removes a small piece of tissue and examines it with a microscope for signs of disease.

X-rays:


X-ray of the stomach is the first step of diagnosis.

Endoscopy:


Endoscopy is a procedure to look at the inside of the stomach using a long, lighted tube through the mouth. During this procedure, a small piece of stomach tissue is removed with accessory tools provided to examine it under the microscope. The procedure is called biopsy.

How is Menetrier Disease treated?


Treatment may include medications to relieve nausea and pain. A high-protein diet is prescribed to offset the loss of protein from enlarged rugae. Part or all of the stomach may need to be removed if the disease is severe.

The anticancer drug cetuximab (Erbitux) blocks the action of TGF-α and is being investigated as a promising new treatment for Menetrier Disease.

Points to Remember


Menetrier Disease causes the ridges along the inside of the stomach wall—called rugae—to enlarge, forming giant folds in the lining of the stomach.

Menetrier Disease is rare and more common in men, usually appearing between the ages of 30 and 60.
Recent studies suggest people with Menetrier Disease have stomachs that make abnormally high amounts of transforming growth factor alpha (TGF-α)—a protein that tells cells what to do.

Menetrier Disease is diagnosed through x rays, endoscopy, and biopsy of stomach tissue.

Treatment for Menetrier Disease may include medications to relieve nausea and pain and surgery to remove part or all of the stomach.