Introduction:
Menetrier disease is a rare condition of massive overgrowth of mucous cells (foveola) in the stomach's mucous membrane, resulting in large gastric folds. The symptom associated with the disease is a pain in the middle epigastric region of the stomach. The term Menetrier disease is generally used to describe any disorder with a large gastric fold or as a synonym for giant hypertrophic gastritis (GHG). However, Menetrier disease should not be associated with gastritis as there is minimal or no inflammation in the stomach.
What Are the Causes of Menetrier Disease?
The exact reason behind Menetrier disease is unknown, but few studies have proposed the following causes:
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In some adults, the bacterium Helicobacter pylori have been implicated as a cause of Menetrier disease. H.pylori is a gram-negative, spiral bacteria generally found in the stomach. It is a common cause of peptic ulcer diseases.
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Cytomegalovirus belongs to the order of the herpes virus. It is a common virus; however, it stays for life once it enters the body. In children, some cases of the disease were associated with cytomegalovirus infection.
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Some researchers believe that large gastric folds may result from hyper-activation of the epidermal growth factor receptor in the stomach. This occurs due to a protein called transforming growth factor alpha.
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In some extremely rare conditions, Menetrier disease may be inherited as an autosomal dominant trait.
What Are the Symptoms of Menetrier Disease?
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Menetrier disease may have different symptoms in different cases. Some cases may be asymptomatic, but some may have epigastric pain (upper middle region of the stomach). Some of the least presented symptoms are nausea, vomiting, diarrhea, weight loss, and loss of appetite.
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One of the variable findings in menetrier disease is the loss of protein from the circulation in the gastrointestinal tract, also known as protein-losing gastropathy. Protein such as albumin is lost from circulation (hypoalbuminemia). This protein loss could be severe in some cases, leading to fluid accumulation (edema), mainly in the legs.
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Some studies present that cases of menetrier disease may have a higher risk of gastric cancer than general people. However, this theory is questionable to other researchers.
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In a few cases, gastrointestinal bleeding has been reported. This bleeding could result from erosion or an ulcer in the stomach lining. Acid secretion by the stomach is often decreased or absent. There might be excess mucous secretion.
What Is the Affected Population?
Menetrier disease affects adults in their fifth decade of life or older. Males are slightly more prone to disease than females.
How to Diagnose Menetrier Disease?
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A barium solution test can diagnose large gastric folds. In this procedure, the patient has to drink a barium solution, and X- rays are taken, which help to trace the gastric folds and the extent of inflammation.
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Endoscopic Examination: In this procedure, a thin, flexible tube known as an endoscope is inserted through the mouth into the stomach, and an evaluation is done. It also helps to collect tissue for microscopic study (biopsy).
What Are the Treatment Options for Menetrier Disease?
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Cases of menetrier disease were treated with the following drug therapies; however, the results were inconsistent.
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Anticholinergic Drugs: These drugs are used to block the action of acetylcholine, which is a neurotransmitter (that transmits signals between certain cells). Some anticholinergic drugs are Atropine, Benztropine mesylate, Dicyclomine, and Clidinium.
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Antibiotics: These are used against H.pylori infection along with proton pump inhibitors. Some examples are Amoxicillin, Metronidazole, Clarithromycin, and Tetracycline.
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Acid Suppression Therapy: The H2 (hydrogen) antagonists suppress gastric acid secretion. Some of them are Ranitidine, Famotidine, and Cimetidine.
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In some cases, to compensate for protein loss, a high-protein diet can be recommended. Albumin transfusion may also be done in cases of albumin loss.
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Administration of Cetuximab can block the epidermal growth factor receptor, thus successful in some patients with menetrier disease. It can improve the quality of life, reduce the thickness of the stomach wall and restore gastric acid production. Some side effects of Cetuximab can be cardiopulmonary arrest, low levels of magnesium, and an acne-like rash.
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Antiviral medication can be administered in children with menetrier disease associated with cytomegalovirus infection, improving symptoms.
What Are the Diseases Similar to Menetrier Disease?
The following disorders can have symptoms similar to menetrier disease:
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Lymphocytic Gastritis: This condition is characterized by stomach inflammation due to inflammatory cells in the stomach's mucosa (inner wall). It results in coiled and abnormal ridges resembling polyps in the stomach's inner lining (large gastric folds). Symptoms may also resemble menetrier diseases such as nausea, vomiting, diarrhea, abdominal pain, and weight loss. Some cases might be asymptomatic.
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Zollinger-Ellison Syndrome (ZES): It is a rare disorder characterized by the development of gastrinoma (neuroendocrine tumors) or tumors secreting high levels of gastrin. Gastrin is responsible for stimulating acid production by the stomach. Gastrinoma is generally malignant in almost half or two-thirds of the cases. Since acid secretion is increased, cases of Zollinger-Ellison syndrome may develop peptic ulcers in the stomach, intestines, or another part of the gastrointestinal tract.
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H. Pylori-Associated Gastritis: Large gastric folds are also seen in such cases.
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Cronkhite-Canada Syndrome: It is a very rare disease in which there is the presence of various intestinal polyps, hair loss, loss of taste, and nail growth issues. It can also be associated with large gastric folds.
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Some carcinomas or lymphoma may also have symptoms similar to menetrier disease.
Conclusion:
Menetrier disease affects the growth of gastric mucosa leading to large gastric folds. Most cases show no symptoms; however, some may develop nausea, vomiting, epigastric pain, weight loss, and abdominal loss. Some cases also present protein loss, such as albumin, which may cause edema in the body. The cause of the disease is unknown, but several studies have been presented to state causes such as bacterial infection (H.pylori) or viral infections such as cytomegalovirus. The treatment includes administering anticholinergic, antibiotics, acid suppression medications, and Cetuximab.
