Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1988 Dec;208(6):694–701. doi: 10.1097/00000658-198812000-00004

Ménétrier's disease. A trivalent gastropathy.

T M Sundt 3rd 1, C C Compton 1, R A Malt 1
PMCID: PMC1493843  PMID: 3264139

Abstract

Current conceptions of Ménétrier's disease only obliquely resemble those originally described. Bona-fide cases are so uncommon that, of 125 cases diagnosed as Ménétier's disease, hypertrophic gastritis, or protein-losing gastropathy treated at the Massachusetts General Hospital during the 26-year period of 1962-1987, only six cases merited an unequivocal anatomic diagnosis. Two other cases previously described proved on review to be nondiagnostic in one instance and Campylobacter pylori gastritis in the other. Because abnormalities in the secretion of gastric acid and in the loss of protein from the stomach may coexist, a representation of each case in semiquantitative terms can be described on triaxial coordinates. Three patients had a hypercoagulable state, one in association with gastric carcinoma. One other case of gastric carcinoma and one of esophageal carcinoma coexistant with Ménétrier's disease were identified. Administration of subcutaneous heparin during the perioperative period to patients with Ménétrier's disease is appropriate regardless of whether or not hypercoagulation or carcinoma is manifest. If treatment with anticholinergic drugs and inhibitors of gastric acid secretion fails, total gastrectomy is the best solution, because it stops protein loss, eliminates hyperchlorhydria, prevents development of gastric carcinoma, and permits anastomotic reconstruction between normal esophagus and normal small bowel.

Full text

PDF
694

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Albo R. J., Peters H. E., Williams R. R. Giant hypertrophic gastritis. Am J Surg. 1973 Aug;126(2):229–234. doi: 10.1016/s0002-9610(73)80157-6. [DOI] [PubMed] [Google Scholar]
  2. BUTZ W. C. Giant hypertrophic gastritis. A report of fourteen cases. Gastroenterology. 1960 Aug;39:183–190. [PubMed] [Google Scholar]
  3. Berenson M. M., Sannella J., Freston J. W. Ménétrier's Disease. Serial morphological, secretory, and serological observations. Gastroenterology. 1976 Feb;70(2):257–263. [PubMed] [Google Scholar]
  4. Brooks A. M., Isenberg J., Goldstein H. Giant thickening of the gastric mucosa with acid hypersecretion and protein-losing gastropathy. Gastroenterology. 1970 Jan;58(1):73–79. [PubMed] [Google Scholar]
  5. Brown L. F., Chester J. F., Malt R. A., Dvorak H. F. Fibrin deposition in autochthonous Syrian hamster pancreatic adenocarcinomas induced by the chemical carcinogen N-nitroso-bis(2-oxopropyl)amine. J Natl Cancer Inst. 1987 May;78(5):979–986. [PubMed] [Google Scholar]
  6. Case records of the Massachusetts General Hospital. Case 2-1988. A 55-year-old man with innumerable gastric polyps and recent melena. N Engl J Med. 1988 Jan 14;318(2):100–109. doi: 10.1056/NEJM198801143180208. [DOI] [PubMed] [Google Scholar]
  7. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 38-1980. N Engl J Med. 1980 Sep 25;303(13):744–750. doi: 10.1056/NEJM198009253031308. [DOI] [PubMed] [Google Scholar]
  8. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 41-1978. N Engl J Med. 1978 Oct 19;299(16):878–884. doi: 10.1056/NEJM197810192991609. [DOI] [PubMed] [Google Scholar]
  9. Elder J. B., Williams G., Lacey E., Gregory H. Cellular localisation of human urogastrone/epidermal growth factor. Nature. 1978 Feb 2;271(5644):466–467. doi: 10.1038/271466a0. [DOI] [PubMed] [Google Scholar]
  10. Fieber S. S., Rickert R. R. Hyperplastic Gastropathy. Analysis of 50 selected cases from 1955-1980. Am J Gastroenterol. 1981 Oct;76(4):321–329. [PubMed] [Google Scholar]
  11. Frank B. W., Kern F., Jr Menetrier's disease. Spontaneous metamorphosis of giant hypertrophy of the gastric mucosa to atrophic gastritis. Gastroenterology. 1967 Dec;53(6):953–960. [PubMed] [Google Scholar]
  12. Gregory H., Walsh S., Hopkins C. R. The identification of urogastrone in serum, saliva, and gastric juice. Gastroenterology. 1979 Aug;77(2):313–318. [PubMed] [Google Scholar]
  13. Gustavsson S., Kelly K. A. Total gastrectomy for benign disease. Surg Clin North Am. 1987 Jun;67(3):539–550. doi: 10.1016/s0039-6109(16)44231-3. [DOI] [PubMed] [Google Scholar]
  14. Heitz P. U., Kasper M., van Noorden S., Polak J. M., Gregory H., Pearse A. G. Immunohistochemical localisation of urogastrone to human duodenal and submandibular glands. Gut. 1978 May;19(5):408–413. doi: 10.1136/gut.19.5.408. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Herfarth C., Schlag P., Buhl K. Surgical procedures for gastric substitution. World J Surg. 1987 Dec;11(6):689–698. doi: 10.1007/BF01656591. [DOI] [PubMed] [Google Scholar]
  16. Johnson L. R. The trophic action of gastrointestinal hormones. Gastroenterology. 1976 Feb;70(2):278–288. [PubMed] [Google Scholar]
  17. Jones E. A., Young W. B., Morson B. C., Dawson A. M. A study of six patients with hypertrophy of the gastric mucosa with particular reference to albumin metabolism. Gut. 1972 Apr;13(4):270–277. doi: 10.1136/gut.13.4.270. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. KENNEY F. D., DOCKERTY M. B., WAUGH J. M. Giant hypertrophy of gastric mucosa; a clinical and pathological study. Cancer. 1954 Jul;7(4):671–681. doi: 10.1002/1097-0142(195407)7:4<671::aid-cncr2820070407>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
  19. Kelly D. G., Miller L. J., Malagelada J. R., Huizenga K. A., Markowitz H. Giant hypertrophic gastropathy (Ménétrier's disease): pharmacologic effects on protein leakage and mucosal ultrastructure. Gastroenterology. 1982 Sep;83(3):581–589. [PubMed] [Google Scholar]
  20. Koga S., Watanabe H., Enjoji M. Stomal polypoid hypertrophic gastritis: a polypoid gastric lesion at gastroenterostomy site. Cancer. 1979 Feb;43(2):647–657. doi: 10.1002/1097-0142(197902)43:2<647::aid-cncr2820430236>3.0.co;2-y. [DOI] [PubMed] [Google Scholar]
  21. Krag E., Frederiksen H. J., Olsen N., Henriksen J. H. Cimetidine treatment of protein-losing gastropathy (Ménétrier's disease). A clinical and pathophysiological study. Scand J Gastroenterol. 1978;13(5):636–639. [PubMed] [Google Scholar]
  22. Kristensen M., Nilsson T. Mucus secretion in hypertrophic, hypersecretory, protein-losing gastropathy. Am J Gastroenterol. 1985 Feb;80(2):77–81. [PubMed] [Google Scholar]
  23. Krol T. C., Isenberg J. I. Remission in a patient with Menetrier's disease: spontaneous or induced by treatment? J Clin Gastroenterol. 1985 Apr;7(2):161–168. doi: 10.1097/00004836-198504000-00010. [DOI] [PubMed] [Google Scholar]
  24. Kubota H., Taguchi O., Suzuki Y., Matsuyama M., Nishizuka Y. Hypertrophic gastritis with hypergastrinemia and protein loss after neonatal thymectomy in mice. Gastroenterol Jpn. 1986 Apr;21(2):122–128. doi: 10.1007/BF02774829. [DOI] [PubMed] [Google Scholar]
  25. Lesser P. B., Falchuk K. R., Singer M., Isselbacher K. J. Menetrier's disease. Report of a case with transient and reversible findings. Gastroenterology. 1975 Jun;68(6):1598–1601. [PubMed] [Google Scholar]
  26. Li A. K., Schattenkerk M. E., Huffman R. G., Ross J. S., Malt R. A. Hypersecretion of submandibular saliva in male mice: trophic response in small intestine. Gastroenterology. 1983 May;84(5 Pt 1):949–955. [PubMed] [Google Scholar]
  27. Marks M. P., Lanza M. V., Kahlstrom E. J., Mikity V., Marks S. C., Kvalstad R. P. Pediatric hypertrophic gastropathy. AJR Am J Roentgenol. 1986 Nov;147(5):1031–1034. doi: 10.2214/ajr.147.5.1031. [DOI] [PubMed] [Google Scholar]
  28. McDermott V. G., Connolly C. E., Finnegan P., O'Gorman T. Menetrier's disease presenting with deep venous thrombosis, iron deficiency anaemia and early evolution to atrophic gastritis. Ir J Med Sci. 1986 Feb;155(2):53–54. doi: 10.1007/BF02939997. [DOI] [PubMed] [Google Scholar]
  29. McKellar Q., Duncan J. L., Armour J., Lindsay F. E., McWilliam P. Further studies on the response to transplanted adult Ostertagia ostertagi in calves. Res Vet Sci. 1987 Jan;42(1):29–34. [PubMed] [Google Scholar]
  30. Olbe L., Lundell L. Intestinal function after total gastrectomy and possible consequences of gastric replacement. World J Surg. 1987 Dec;11(6):713–719. doi: 10.1007/BF01656593. [DOI] [PubMed] [Google Scholar]
  31. Overholt B. F., Jeffries G. H. Hypertrophic, hypersecretory protein-losing gastropathy. Gastroenterology. 1970 Jan;58(1):80–87. [PubMed] [Google Scholar]
  32. Palmer E. D. What Menetrier really said. Gastrointest Endosc. 1968 Nov;15(2):83–passim. [PubMed] [Google Scholar]
  33. Polga J. P., Spencer R. P. Menetrier's disease with occlusion of splenic and brachial arteries. Clin Nucl Med. 1982 Nov;7(11):526–527. doi: 10.1097/00003072-198211000-00008. [DOI] [PubMed] [Google Scholar]
  34. Pozharisski K. M. The significance of nonspecific injury for colon carcinogenesis in rats. Cancer Res. 1975 Dec;35(12):3824–3830. [PubMed] [Google Scholar]
  35. REESE D. F., HODGSON J. R., DOCKERTY M. B. Giant hypertrophy of the gastric mucosa (Menetrier's disease):a correlation of the roentgenographic, pathologic, and clinical findings. Am J Roentgenol Radium Ther Nucl Med. 1962 Oct;88:619–626. [PubMed] [Google Scholar]
  36. Reinhart W. H., Weigand K., Kappeler M., Roesler H., Halter F. Comparison of gastrointestinal loss of alpha-1-antitrypsin and chromium-51-albumin in Ménétrier's disease and the influence of ranitidine. Digestion. 1983;26(4):192–196. doi: 10.1159/000198889. [DOI] [PubMed] [Google Scholar]
  37. Rotstein J., Sarma D. S., Farber E. Sequential alterations in growth control and cell dynamics of rat hepatocytes in early precancerous steps in hepatocarcinogenesis. Cancer Res. 1986 May;46(5):2377–2385. [PubMed] [Google Scholar]
  38. Russell I. J., Smith J., Dozois R. R., Wahner H. W., Bartholomew L. G. Menetrier's disease. Effect of medical and surgical vagotomy. Mayo Clin Proc. 1977 Feb;52(2):91–96. [PubMed] [Google Scholar]
  39. STEMPIEN S. J., DAGRADI A. E., REINGOLD I. M., HEISKELL C. L., GOODMAN J. R., BLOOM A., WEAVER D. S. HYPERTROPHIC HYPERSECRETORY GASTROPATHY. ANALYSIS OF 15 CASES AND A REVIEW OF THE PERTINENT LITERATURE. Am J Dig Dis. 1964 Jul;9:471–493. doi: 10.1007/BF02283918. [DOI] [PubMed] [Google Scholar]
  40. Scharschmidt B. F. The natural history of hypertrophic gastrophy (Menetrier's disease). Report of a case with 16 year follow-up and review of 120 cases from the literature. Am J Med. 1977 Oct;63(4):644–652. doi: 10.1016/0002-9343(77)90210-8. [DOI] [PubMed] [Google Scholar]
  41. Scott H. W., Jr, Shull H. J., Law D. H., 4th, Burko H., Page D. L. Surgical management of Menetrier's disease with protein-losing gastropathy. Ann Surg. 1975 May;181(5):765–777. doi: 10.1097/00000658-197505000-00036. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Searcy R. M., Malagelada J. R. Ménétrièr's disease and idiopathic hypertrophic gastropathy. Ann Intern Med. 1984 Apr;100(4):565–570. doi: 10.7326/0003-4819-100-4-565. [DOI] [PubMed] [Google Scholar]
  43. Smith R. L., Powell D. W. Prolonged treatment of menetrier's disease with an oral anticholinergic drug. Gastroenterology. 1978 May;74(5 Pt 1):903–906. [PubMed] [Google Scholar]
  44. Snider T. G., 3rd, Ochoa R., Williams J. C. Menetrier's disease. Pre-Type II and Type II ostertagiosis in cattle. Am J Pathol. 1983 Dec;113(3):410–412. [PMC free article] [PubMed] [Google Scholar]
  45. Troidl H., Kusche J., Vestweber K. H., Eypasch E., Maul U. Pouch versus esophagojejunostomy after total gastrectomy: a randomized clinical trial. World J Surg. 1987 Dec;11(6):699–712. doi: 10.1007/BF01656592. [DOI] [PubMed] [Google Scholar]
  46. Tutton P. J., Barkla D. H. Biogenic amines as regulators of the proliferative activity of normal and neoplastic intestinal epithelial cells (review). Anticancer Res. 1987 Jan-Feb;7(1):1–12. [PubMed] [Google Scholar]
  47. Walker F. B., 4th Spontaneous remission in hypertrophic gastropathy (Menetrier's disease). South Med J. 1981 Oct;74(10):1273–1276. doi: 10.1097/00007611-198110000-00037. [DOI] [PubMed] [Google Scholar]
  48. Wijngaards G., Jespersen J. Fibrinolytic activity of the gastric mucosa in Ménétrièr's disease. Eur J Clin Invest. 1983 Aug;13(4):347–350. doi: 10.1111/j.1365-2362.1983.tb00111.x. [DOI] [PubMed] [Google Scholar]
  49. Williamson R. C. Intestinal adaptation (first of two parts). Structural, functional and cytokinetic changes. N Engl J Med. 1978 Jun 22;298(25):1393–1402. doi: 10.1056/NEJM197806222982505. [DOI] [PubMed] [Google Scholar]
  50. van der Gaag I. Hypertrophic gastritis in 21 dogs. Zentralbl Veterinarmed A. 1984 Apr;31(3):161–173. doi: 10.1111/j.1439-0442.1984.tb01272.x. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES