Menetrier disease

Menetrier disease Menetrier disease known as hypertrophic gastropathy hipoproteica, giant hypertrophic gastritis is a rare premalignant stomach. It is characterized by the formation of giant hypertrophic folds massive mucus secretion, reduced acid secretion and severe hypoproteinemia by selective loss of serum proteins by gastric folds.
Altered gastric mucosa secrete massive amounts of mucus protein lowers plasma levels. Tissue may be inflamed and may contain ulcers. The disease also deetrmina fluid rich in albumin loss. There are two forms of the disease: a child and other adults. The form that affects children has a better prognosis. Boys and girls are equally affected, most often after a viral infection caused by cytomegalovirus or bacterial infection with Helicobacter pylori. Children are not born with Menetrier disease and it is not hereditary. Adult form is related to overexpression of growth factor alpha.
Menetrier disease symptoms include nausea, epigastric pain, weight loss, diarrhea and melena. Hypoproteinemia cause severe ascites and peripheral edema. The condition must be differentiated from other forms of hypertrophic gastritis, such as Zollinger-Ellison syndrome, hypertrophic gastropathy hipersecretorie, lymphocytic gastritis and gastric carcinoma. Diagnosis is based on gastroscopiei with gastric mucosa biopsy. Transabdominal ultrasound helps to distinguish patients with giant gastric folds associated with malignancies than in those with benign conditions.
Treatment includes medication to control nausea and pain. It prescribes a diet rich in protein. If the disease is severe, indicating partial or total resection of the stomach. Recent research has investigated the role of cetuximab, an antineoplastic agent which blocks the action of growth factor alpha, Menetrier disease with promising results.
Pathogenesis and causes
Recent studies involving overproduction and transforming growth factor alpha to epidermal growth stimulation and overexpression of epidermal receptor in the pathogenesis of the condition. Activation of epidermal growth receptor, a transmembrane receptor tyrosine kinases activity, triggers a cascade of cellular signaling mechanisms that lead to the expansion of the proliferative compartment of gastric mucosal cell oxintice. The result is increased production of mucus and decrease the stomach acid. The existence of the disease in twins suggests that at least some cases genetic etiology.
A similar hypertrophic gastritis has been recognized and infection with Helicobacter pylori infection in children in citomeglus virus. Recent studies show that Helicobacter bacteria isolated from patients with Menetrier's disease is genetically different from that isolated from patients with other gastric diseases.
Signs and symptoms
Menetrier disease (giant gastric folds) is a rare distinct entity usually occurs after age 50 years, men were more affected, clinically characterized by epigastric pain, weight loss, swelling, decreased gastric acidity, hypoalbuminemia, endoscopic giant folds mucosal histology and thickness increase with foveolara hyperplasia and glandular atrophy. It is associated with increased risk of gastric cancer and require supervision. The diagnosis is endoscopic appearance of being giant folds comprising fornix, the stomach and sometimes Antrim, but pliable mucosa is usually covered with viscous mucus. On histological examination often can identify issues and lymphocytic gastritis, which would suggest as a possible etiology is infection with cytomegalovirus in childhood. Risk 20 times higher than the general population of gastrectomy for gastric cancer is the most effective possible treatment option.
Menetrier disease symptoms include: -Postprandial pain, relieved by antacids Weight-loss, cachexia , Peripheral edema, ascites Blood-loss anemia secondary.
Diagnosis
Gastroscopy is the most effective imaging method for direct visualization of the stomach lining and allow sampling by biopsy. Foveolara characteristic histological changes include hyperplasia, cystic dilatation of mucous glands and reduce the number of parietal cells.
The differential diagnosis is made with the following conditions: Zollinger-Ellison syndrome, hypertrophic gastropathy hipersecretorie, lymphocytic gastritis and gastric carcinoma.
Treatment
There is evidence of citomegalus virus infection in children and its association with Menetrier's disease and Helicobacter pylori infection, these infections must be eradicated. Chronic disease is sometimes relieved by administration of antagonists of hydrogen or proton pump inhibitors. Octreotide, a somatostatin analogue has been used with beneficial effects in some patients and may preclude the need for surgery. Erbitux, a monoclonal antibody that blocks the receptor binding of epidermal growth showed promising results in some patients.
Therapies that aim to increase the signal receptor and epidermal growth showed beneficial, including somatostatin analogs and monoclonal antibodies (cetuximab) directed against the receptor. Partial gastrectomy is recommended occasionally for persistent symptoms and uncontrollable Enteropathy with loss of protein. Due to the high risk of gastric malignant transformation recommend total gastrectomy.