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EDITOR’S QUIZ: GI SNAPSHOT

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From question on page 1572

Upper gastrointestinal endoscopy showed polypoid masses (fig 1). There were multiple large polypoid lesions distributed throughout the body, fundus, and cardia of the stomach, with characteristic antral sparing. Endoscopic ultrasound demonstrated diffuse and regular gastric wall thickening of the second layer, corresponding to the mucosa (between the arrows in fig 2) with preservation of wall stratification. A full thickness gastric mucosal biopsy revealed foveolar hyperplasia with cystic dilation (fig 3). The pathological diagnosis was Menetrier’s disease.

Menetrier’s disease (hypertrophic protein losing gastropathy) is a rare clinical entity of unknown aetiology. It is characterised by giant gastric folds associated with epithelial hyperplasia.1 A polypoid variant of Menetrier’s disease has been described that resembles multiple hyperplasic gastric polyps. Menetrier’s disease is typically associated with protein losing gastropathy and with hypochlorhydia. Patients may present with weight loss, epigastric pain, vomiting, anorexia, oedema, and haematemesis. Of the 200 cases of Menetrier’s disease reported in the literature, 30 (15%) have been associated with carcinoma.1 Ideal treatment of hyperplasic gastropathy is unclear. In patients not responding to medical therapy, partial or total gastric resection is reserved for severe complications, such as refractory or recurrent bleeding, obstruction, severe hypoproteinaemia, or cancer development. The differential diagnosis for the endoscopic appearances includes lymphoma, Zollinger-Ellison syndrome, amyloidosis, eosinophilic gastritis, and infiltrative neoplastic entities.

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