Menetrier Disease

Learning points from NEJM Case " Unfolding The Diagnosis " April 3 2014

1) Low albumin can be due to 3 reasons

• Liver - look for liver enzymes, bilirubin and coagulation profile abnormalities
• Kidney - look for proteinuria > 3.5 g/day
• GI - malabsorption syndromes ( pancreatitis, celiac disease, crohn's disease and Menetrier disease )

2) Large gastric fold can be due to

• Hyperplasia:- Menetrier disease ( hyperplastic hypoproteinemic gastropathy)
  - ZES ( parietal cells hyperplasia due to gastrin stimulation )

• Non hyperplastic mucosal hypertrophy :
  - Chronic inflammation - chronic gastritis due to H.pylori
  - Infiltration/cancer - sarcoidosis, eosinophilic gastroenteritis, linitis plastica

3) The diagnosis of Menetrier disease can be done by 

• CT scan showing thickened gastric folds
• Endoscopy - show thickened folds
• Definitive by biopsy and histological examination

4) Menetrier disease patient commonly presents with GI symptoms and low albumin, if there is viral prodromal symptoms, suspect occult CMV infections

Reference

Unfolding the Diagnosis Gadi Lalazar, M.D., Victoria Doviner, M.D., and Eldad Ben-Chetrit, M.D.  N Engl J Med 2014; 370:1344-1348 April 3, 2014