Correspondence

Menetrier's Disease and Helicobacter pylori

N Engl J Med 1993; 329:60July 1, 1993

Article

To the Editor:

Protein-losing hypertrophic gastropathy is a life-threatening disease characterized by hypoproteinemia,1 often with the development of gastric cancer2. In a retrospective study of 138 patients, we found that hypertrophic gastropathy was associated with Helicobacter pylori in more than 90 percent of cases3. This finding encouraged us to treat a 28-year-old woman for Menetrier's disease associated with protein-losing gastropathy. She had been treated with cimetidine for more than three years, with little benefit, when colonization with H. pylori was detected. H. pylori was also found on examination of biopsy specimens obtained five years earlier, before treatment with H₂-blockers was begun. The density of H. pylori colonization and the degree of gastritis were more pronounced in the gastric body than in the gastric antrum, findings characteristic of H. pylori gastritis3. The patient was treated with a 14-day course of amoxicillin (750 mg three times a day) and omeprazole (40 mg three times a day), which was a modification of a previously reported regimen4. Within six weeks this therapy led to the eradication of H. pylori, with normalization of the giant folds and the mucosal histologic features. Serum protein concentrations, which had ranged from 3.5 to 5.6 g per deciliter, increased to the normal range (6.0 to 8.0 g per deciliter). The gastric mucosa remained normal on endoscopy one and two years after treatment. A similar course after antibacterial treatment has been reported by Salmeron et al5. Menetrier's disease may be characterized by hypersecretory hyperchlorhydria, by hypochlorhydria, protein loss, and hypoproteinemia, or by variations of these two forms1. The natural history of hypertrophic gastropathy often includes spontaneous regression of the hypertrophic folds, coincident with the development of atrophic gastritis in the gastric body, which may also be the end point of progressive H. pylori gastritis3. The atrophy typically spares the mucosa in the body of the stomach, which may result in ongoing protein loss.

Improvement after the eradication of H. pylori could help in the differential diagnosis of other diseases associated with hypertrophic gastric folds, such as diffuse gastric carcinoma or lymphoma. In at least some patients with Menetrier's disease, the mucosal lesions may heal after the eradication of H. pylori.

E. Bayerdorffer, M.D.
M.M. Ritter, M.D.
R. Hatz, M.D.
W. Brooks, Ph.D.
Klinikum Grosshadern, University of Munich, D-81377 Munich 70, Germany

M. Stolte, M.D.
Institute for Pathology, Klinikum Bayreuth, D-95445 Bayreuth, Germany

5 References

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Citing Articles (8)

Citing Articles

1. 1

   Thomas Tran, Patrick Hung, Rodolfo Laucirica, Raouf E. Hilal, Richard W. Goodgame. (2002) The Clinical Significance of Thickened Gastric Folds Found on Upper Gastrointestinal Series. Journal of Clinical Gastroenterology 35:2, 138-143
   CrossRef

2. 2

   Brian R. Landzberg, Mark B. Pochapin. (2001) Protein-losing enteropathy and gastropathy. Current Treatment Options in Gastroenterology 4:1, 39-49
   CrossRef

3. 3

   Marie-Clotilde Charton-Bain, François Paraf, Patrick Bruneval. (2000) Superficial Gastric Carcinoma Developed on Localized Hypertrophic Lymphocytic Gastritis: A Variant of Localized Ménétrier's Disease?. Pathology - Research and Practice 196:2, 125-128
   CrossRef

4. 4

   Ranjan Dohil, Eric Hassall, Gareth Jevon, James Dimmick. (1999) Gastritis and Gastropathy of Childhood. Journal of Pediatric Gastroenterology & Nutrition 29:4, 378-394
   CrossRef

5. 5

   Tadashi Shimoyama, Shinsaku Fukuda, Masanori Tanaka, Tatsuya Mikami, Ryo Yamagata, Tetsuro Yoshimura, Yoichi Haga, Yuhji Murata, Akihiro Munakata. (1998) Healing of Cimetidine-Resistant Ménétrier's Disease by Eradication of Helicobacter pylori Infection. Journal of Clinical Gastroenterology 27:4, 348-350
   CrossRef

6. 6

   B. Stamm. (1997) Localized Hyperplastic Gastropathy of the Mucous Cell- and Mixed Cell-Type (Localized Ménétrier's Disease): A Report of 11 Patients. The American Journal of Surgical Pathology 21:11, 1334-1342
   CrossRef

7. 7

   J.R. Graham. (1995) Helicobacter pylori: human pathogen or simply an opportunist?. The Lancet 345:8957, 1095-1097
   CrossRef

8. 8

   Tadashi SHIMOYAMA, Shinsaku FUKUDA, Tatsuya MIKAMI, Akihiro MUNAKATA, Yutaka YOSHIDA, Yoshimasa KAMATA. (1995) A Case of Giant Gastric Folds with Hypoalbuminemia Healed by Helicobacter pylori Eradication. Digestive Endoscopy 7:2, 185-189
   CrossRef