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From question on page 330

These histological findings are characteristic of Menetrier’s disease; a rare and acquired disorder of the stomach. Criteria for diagnosis include giant gastric folds, histological features of marked foveolar hyperplasia, atrophy of glands, and increase in mucosal thickness. There is excess mucus production, decreased acid secretion, and hypoproteinaemia. The differential diagnosis includes Zollinger-Ellison syndrome, Helicobacter pylori infection, gastric lymphoma, cytomegalovirus infection, gastric cancer, and eosinophilic gastritis. The pathogenesis involves elevated levels of transforming growth factor α (TGF-α) in gastric mucous cells, which exerts its effect by binding to the epidermal growth factor receptor. TGF-α increases gastric mucous production, cell renewal, and inhibits acid secretion. Hypoproteinaemia occurs due to selective loss of serum proteins across the gastric mucosa. The patient underwent total gastrectomy due to ongoing blood loss that was difficult to manage, with iron and blood supplementation without complications. The patient continues to do well one year after surgery with no anaemia, gastrointestinal bleeding, or abdominal pain.

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