Ménétrier Disease USMLE Notes

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Ménétrier Disease USMLE Notes & Mnemonics contains all the high-yield points you need to know.

Ménétrier Disease: Rare, acquired pre-malignant condition characterized by hypertrophic gastropathy with enlarged gastric folds. (Ref)

Pathophysiology

Marked hypertrophy of the gastric mucosa, especially the rugae of the stomach, leading to excessive mucous production and reduced acid production.
Protein-losing enteropathy due to increased permeability of the gastric mucosa.
Potential increase in risk of gastric adenocarcinoma.

Clinical Features

Abdominal pain
Weight loss
Edema due to hypoalbuminemia (protein-losing enteropathy)
Nausea and vomiting
Diarrhea
Anorexia
Gastrointestinal bleeding

Mnemonic: “MÉNÉTRIER’S“

M = Massive gastric folds
É = Edema (due to hypoalbuminemia)
N = Nausea
É = Excess mucus production
T = Transformation risk (gastric carcinoma)
R = Rugae hypertrophy
I = Intrinsic factor decrease, leading to possible vitamin B12 deficiency
E = Eating problems (anorexia, weight loss)
R = Reduced acid production
S = Stomach pain

Diagnosis

Endoscopy with biopsy: Crucial for diagnosis; giant gastric folds and foveolar hyperplasia.
Serum protein levels: Hypoalbuminemia.
Imaging: CT scan or gastric ultrasonography may show thickened gastric mucosa.
Stool alpha-1 antitrypsin clearance: To assess for protein-losing enteropathy.

Management

Supportive treatment: Nutrition and management of hypoalbuminemia.
Medical treatment: Proton pump inhibitors; anticholinergic agents have been used but with variable success.
Octreotide: May help reduce protein loss.
Cytomegalovirus (CMV) treatment: If CMV is thought to be a contributing factor.
Surgery: Partial gastrectomy for severe disease not responsive to medical therapy, especially if there is significant bleeding or malignant transformation.

Prognosis

Chronic condition with variable course.
Increased risk for gastric carcinoma.
Surgical treatment may be curative, but relapses can occur.

Complications

Gastric cancer: Increased risk.
Anemia: Due to chronic protein loss and potential chronic blood loss.

Note: Ménétrier’s disease is a rare condition with an uncertain natural history, and evidence-based management is limited. Care should be taken to monitor for malignant transformation. Always consider current clinical guidelines and evidence when treating patients.

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