Distinguishing Ménétrier's disease from its mimics
| Autor: | Robert J. Coffey, Hubert Piessevaux, Tania Zuluaga Toro, William H. Fiske, Jarred P. Tanksley, Christopher D. Lind, Mary Kay Washington, Gregory D. Ayers, Amy Rich |
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| Přispěvatelé: | UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie, UCL - Service de gastro-entérologie |
| Jazyk: | angličtina |
| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty Abdominal pain Adolescent Nausea Biopsy Decision Making Stomach Diseases Peripheral edema Disease Gastroenterology Article Diagnosis Differential Young Adult Polyps Internal medicine Gastroscopy medicine Humans Gastritis Hypertrophic Polyps - diagnosis Retrospective Studies Aged business.industry Middle Aged medicine.disease Ménétrier's disease Gastric Mucosa - pathology Gastric Mucosa Vomiting Stomach Diseases - diagnosis Female Gastritis Hypertrophic - complications diagnosis pathology medicine.symptom Gastritis Differential diagnosis business Algorithms |
| Zdroj: | Gut, Vol. 59, no. 12, p. 1617-24 (2010) |
| Popis: | Ménétrier's disease (MD) is a rare hypertrophic gastropathy characterised by giant rugal folds, hypochlorhydria, protein loss and a classic constellation of symptoms (nausea, vomiting, abdominal pain and peripheral oedema). It is considered a clinical diagnosis that may at times be difficult to establish. Firm diagnostic criteria for MD are proposed by delineating the clinicopathological features that best differentiate MD from its mimics.48 patients referred to Vanderbilt University Medical Center for consideration of enrolment in a clinical trial of treatment of patients with MD with cetuximab were evaluated for a definitive diagnosis by assessing the clinical presentation, pertinent laboratory values and histopathological features.MD was confirmed in 25 of the 48 patients (52%). The remaining 23 patients were considered to be mimics of MD, the most common diagnoses being gastric polyps or polyposis syndromes (13/23, 57%). Gastric slides were available from 40 of the 48 patients for detailed histological analysis (22/25 MD and 18/23 non-MD). Foveolar hyperplasia, glandular tortuosity and dilation, and a marked reduction in parietal cell number were present in all 22 cases of MD. Lamina propria smooth muscle hyperplasia and oedema characterised most cases (18/22 and 19/22, respectively). More than half had prominent eosinophils (11/22) and/or plasma cells (12/22) in the lamina propria. The clinical presentation of patients with MD was characterised by significantly younger age of onset, male predominance and increased vomiting compared with non-MD patients, and a lower prevalence of anaemia compared with MD patients with polyps. There was a trend towards increased frequency of peripheral oedema in patients with MD compared with non-MD patients.MD is most accurately diagnosed by clinicohistopathological analysis including oesophagogastroduodenoscopy with gastric pH, appropriate laboratory tests (complete blood count, serum albumin, serum gastrin, Helicobacter pylori and cytomegalovirus serology) and full-thickness mucosal biopsy of the involved gastric mucosa. |
| Databáze: | OpenAIRE |
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