Hyperplastic Gastropathies

Background

These rare diseases are characterized by large rugal folds secondary to hyperplastic gastric mucosa. One radiologic definition defines it as folds are those greater than 8 mm in width, while endoscopic large folds are greater than 1 cm in height.

DISEASE ASSOCIATIONS CHARACTERIZATION

Hypertrophic gastropathy with gastric adenocarcinoma: Menetrier's disease and lymphocytic gastritis?

Mosnier JF, Flejou JF, Amouyal G, Gayet B, Molas G, Henin D, Potet F.

Service d'Anatomie et Cytologie Pathologiques, Hopital Beaujon, Clichy, France.

Gut 1991 Dec;32(12):1565-7 Abstract quote

Lymphocytic gastritis is a form of gastric inflammation characterised by a pronounced increase in lymphocytes in gastric surface and foveolar epithelium. Lymphocytic gastritis is often associated with endoscopic evidence of 'varioliform gastritis'. Lymphocytic gastritis has recently been reported to be associated with other forms of hypertrophic gastropathies.

We present a case of hypertrophic gastropathy with gastric adenocarcinoma, with both Menetrier's disease and lymphocyte gastritis. Immunohistochemical studies showed that the intraepithelial lymphocytes were predominantly alpha/beta T cells as in the normal stomach and not gamma/delta T cells as in coeliac sprue.

This case together with the six recently published cases suggests that Menetrier's disease and lymphocytic gastritis may be part of the same disease spectrum.

Hypertrophic lymphocytic gastritis with a gastric carcinoma.

Vandenborre KM, Ghillebert GL, Rutgeerts LJ, Geboes KR, Rutgeerts PJ, Verbanck JJ, Tanghe WR.

Department of Medicine, Hospital Heilig Hart, Roeselare, Belgium.

Eur J Gastroenterol Hepatol 1998 Sep;10(9):797-801 Abstract quote

Lymphocytic gastritis is a recently described gastric inflammation, characterized by an increased intraepithelial lymphocytic infiltrate mainly composed of T-lymphocytes. Endoscopically it correlates mainly with diffuse varioliform gastritis. Menetrier's disease is a hypertrophic gastropathy with enlarged gastric folds. The histological picture is that of foveolar hyperplasia and glandular cysts of the mucosa. A few small series of lymphocytic gastritis with microscopic and endoscopic features of Menetrier's disease have been published previously.

We describe a similar case associated with a gastric adenocarcinoma.

LABORATORAY/RADIOLOGIC/
OTHER CHARACTERIZATION

Endoscopic ultrasound features of protein-losing gastropathy with hypertrophic gastric folds.

Hizawa K, Kawasaki M, Yao T, Aoyagi K, Suekane H, Kawakubo K, Fujishima M.

Second Dept. of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan.

Endoscopy 2000 May;32(5):394-7 Abstract quote

BACKGROUND AND STUDY AIMS: We aim to clarify the endoscopic ultrasound (EUS) features of protein-losing gastropathy with hypertrophic gastric folds (PLGH), including Menetrier's disease.

PATIENTS AND METHODS: We analyzed the EUS and histologic findings in five patients who underwent both endoscopic ultrasonography and endoscopic resection.

RESULTS: Histologically, we diagnosed one patient as having acute gastritis, three patients as having Menetrier's disease, and the remaining patient as having hypertrophic lymphocytic gastritis (HLG). Helicobacter pylori was recognized in all but one patient. At EUS every patient was found to have giant gastric folds (13 to 20 mm in diameter), resulting from echogenic thickening of the mucosal layer with or without cystic components. Two patients who underwent eradication therapy of H. pylori showed both clinical and morphologic resolution.

CONCLUSIONS: Echogenic thickening of the mucosal layer may be a characteristic EUS feature of protein-losing gastropathy with hypertrophic gastric folds, and H. pylori may be one of the causative agents.

HISTOPATHOLOGICAL VARIANTS CHARACTERIZATION

Menetrier's disease with lymphocytic gastritis: an unusual association with possible pathogenic implications.

Haot J, Bogomoletz WV, Jouret A, Mainguet P.

Service d'Anatomie Pathologique, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.

Hum Pathol 1991 Apr;22(4):379-86 Abstract quote

Menetrier's disease is a rare form of hypertrophic or hyperplastic gastropathy, characterized by conspicuous thickening of the gastric mucosal folds and foveolar (crypt) hyperplasia. The pathogenesis of Menetrier's disease remains unresolved. Lymphocytic gastritis is a newly described entity which corresponds endoscopically to varioliform gastritis and is marked by T-lymphocyte infiltration of the surface epithelium and crypts.

Five surgical cases and one autopsy case combining the gross and microscopic features of Menetrier's disease and lymphocytic gastritis are presented.

This unusual and hitherto previously undescribed association raises the possibility of a common pathogenesis for Menetrier's disease and lymphocytic gastritis.

Menetrier's disease: a form of hypertrophic gastropathy or gastritis?

Wolfsen HC, Carpenter HA, Talley NJ.

Division of Gastroenterology and Internal Medicine, Mayo Clinic, Rochester, Minnesota.

Gastroenterology 1993 May;104(5):1310-9 Abstract quote

BACKGROUND: Menetrier's disease is characterized by giant gastric folds and foveolar hyperplasia. The extent of mucosal inflammation and glandular atrophy, however, is controversial. The aim of this study was to test the hypothesis that patients previously diagnosed with Menetrier's disease actually represent at least two diseases: (1) Hypertrophic lymphocytic gastritis (HLG) and (2) Massive foveolar hyperplasia and minimal inflammation (MFH).

METHODS: All cases of possible Menetrier's disease were identified, and their clinical, laboratory, and pathological data were reviewed. In twenty-three patients with giant fundal folds, full-thickness tissue specimens (n = 19) or large suction biopsy (n = 4) tissue specimens were obtained.

RESULTS: Two distinct, nonoverlapping histological patterns were found; 13 patients had HLG and 10 patients had MFH. Clinical features and frequency of Helicobacter pylori were similar in these two groups. Patients with HLG had severe inflammation with numerous intraepithelial lymphocytes and mild foveolar hyperplasia. Alternatively, patients with MFH had greater foveolar hyperplasia, significantly thicker mucosa, and greater mucosal edema.

CONCLUSIONS: Patients with MFH represent a form of hypertrophic gastropathy and should be designated as having Menetrier's disease, whereas patients with HLG should be considered part of the spectrum of lymphocytic gastritis.

PROGNOSIS AND TREATMENT CHARACTERIZATION

PROGNOSIS

Ten year follow up study of lymphocytic gastritis: further evidence on Helicobacter pylori as a cause of lymphocytic gastritis and corpus gastritis.

Niemela S, Karttunen T, Kerola T, Karttunen R.

Department of Internal Medicine, University Hospital of Oulu, Finland.

J Clin Pathol 1995 Dec;48(12):1111-6 Abstract quote

AIMS--To examine the course of lymphocytic gastritis and its relation to Helicobacter pylori (H pylori) infection in a 10 year follow up.

METHODS--Ninety six patients were originally examined for dyspepsia in 1981. Gastroscopies with stepwise biopsies were performed on all the patients initially and after an interval of 10 years.

RESULTS--Nine per cent of the patients (9/96) had features of lymphocytic gastritis in gastric biopsy at the first examination, and 12.5% (12/96) at the second examination; 7/9 patients (78%) had persistent lymphocytic gastritis during the follow up; in two the diagnostic features of lymphocytic gastritis had disappeared, and five had a new diagnosis of lymphocytic gastritis at the second examination. At the second examination 9/12 lymphocytic gastritis patients (75%) were H pylori positive histologically, while all had specific antibodies to H pylori. The lymphocytic gastritis patients had higher grades of gastritis (p = 0.009), neutrophilic and eosinophilic granulocytes, mononuclear inflammatory cells, and foveolar hyperplasia in the corpus mucosa, but smaller numbers of H pylori, than the H pylori positive patients without lymphocytic gastritis. The appearance of lymphocytic gastritis during the 10 year interval was associated with increases in the grades of corpus gastritis and neutrophilic granulocytes (p = 0.043 for both). During the follow up, the patients with lymphocytic gastritis, but not the H pylori positive patients without lymphocytic gastritis, appeared to have a significant increase in the grade of intestinal metaplasia in the corpus mucosa (p = 0.043).

CONCLUSIONS--In some patients H pylori may cause a gastritis that predominates in the corpus and is associated with an increase in the intraepithelial lymphocyte count. This form of gastritis may cause progression of intestinal metaplasia.

TREATMENT

Healing of protein losing hypertrophic gastropathy by eradication of Helicobacter pylori--is Helicobacter pylori a pathogenic factor in Menetrier's disease?

Bayerdorffer E, Ritter MM, Hatz R, Brooks W, Ruckdeschel G, Stolte M.

Medical Department II, Klinikum Grosshadern, University of Munich, Germany.

Gut 1994 May;35(5):701-4 Abstract quote

Hypertrophic gastropathy--that is, Menetrier's disease--was found, in a retrospective analysis, to be associated with Helicobacter pylori in more than 90% of patients. It is proposed that hypertrophic gastropathy represents a special form of H pylori gastritis in these patients.

A case is described of a 28 year old woman with Menetrier's disease associated with proved protein loss from the stomach. Treatment with cimetidine for more than three years had little benefit when colonisation by H pylori was detected. Density of H pylori colonisation and activity of gastritis, which was also present in the first biopsy specimens taken five years ago, were more pronounced in the body than in the antrum, which is in agreement with the characteristics of H pylori gastritis found in other cases with Menetrier's disease. A 14 day antibacterial treatment course with 750 mg amoxicillin three times a day combined with 40 mg omeprazole three times a day was started in April 1991. This resulted in eradication of H pylori and the return to normal of giant folds and the mucosal histology. Serum protein concentrations returned to normal within six weeks and remained normal at two endoscopies during a two year follow up.

This case report suggests that a subgroup of the patients with Menetrier's disease may be healed by the eradication of H pylori.

Sternberg S. Diagnostic Surgical Pathology. Third Edition. Lipincott Williams and Wilkins 1999.

Commonly Used Terms

Stomach

Last Updated 4/19/2001

PROGNOSIS AND TREATMENT	CHARACTERIZATION
PROGNOSIS
Ten year follow up study of lymphocytic gastritis: further evidence on Helicobacter pylori as a cause of lymphocytic gastritis and corpus gastritis. Niemela S, Karttunen T, Kerola T, Karttunen R. Department of Internal Medicine, University Hospital of Oulu, Finland.	J Clin Pathol 1995 Dec;48(12):1111-6 Abstract quote AIMS--To examine the course of lymphocytic gastritis and its relation to Helicobacter pylori (H pylori) infection in a 10 year follow up. METHODS--Ninety six patients were originally examined for dyspepsia in 1981. Gastroscopies with stepwise biopsies were performed on all the patients initially and after an interval of 10 years. RESULTS--Nine per cent of the patients (9/96) had features of lymphocytic gastritis in gastric biopsy at the first examination, and 12.5% (12/96) at the second examination; 7/9 patients (78%) had persistent lymphocytic gastritis during the follow up; in two the diagnostic features of lymphocytic gastritis had disappeared, and five had a new diagnosis of lymphocytic gastritis at the second examination. At the second examination 9/12 lymphocytic gastritis patients (75%) were H pylori positive histologically, while all had specific antibodies to H pylori. The lymphocytic gastritis patients had higher grades of gastritis (p = 0.009), neutrophilic and eosinophilic granulocytes, mononuclear inflammatory cells, and foveolar hyperplasia in the corpus mucosa, but smaller numbers of H pylori, than the H pylori positive patients without lymphocytic gastritis. The appearance of lymphocytic gastritis during the 10 year interval was associated with increases in the grades of corpus gastritis and neutrophilic granulocytes (p = 0.043 for both). During the follow up, the patients with lymphocytic gastritis, but not the H pylori positive patients without lymphocytic gastritis, appeared to have a significant increase in the grade of intestinal metaplasia in the corpus mucosa (p = 0.043). CONCLUSIONS--In some patients H pylori may cause a gastritis that predominates in the corpus and is associated with an increase in the intraepithelial lymphocyte count. This form of gastritis may cause progression of intestinal metaplasia.
TREATMENT
Healing of protein losing hypertrophic gastropathy by eradication of Helicobacter pylori--is Helicobacter pylori a pathogenic factor in Menetrier's disease? Bayerdorffer E, Ritter MM, Hatz R, Brooks W, Ruckdeschel G, Stolte M. Medical Department II, Klinikum Grosshadern, University of Munich, Germany.	Gut 1994 May;35(5):701-4 Abstract quote Hypertrophic gastropathy--that is, Menetrier's disease--was found, in a retrospective analysis, to be associated with Helicobacter pylori in more than 90% of patients. It is proposed that hypertrophic gastropathy represents a special form of H pylori gastritis in these patients. A case is described of a 28 year old woman with Menetrier's disease associated with proved protein loss from the stomach. Treatment with cimetidine for more than three years had little benefit when colonisation by H pylori was detected. Density of H pylori colonisation and activity of gastritis, which was also present in the first biopsy specimens taken five years ago, were more pronounced in the body than in the antrum, which is in agreement with the characteristics of H pylori gastritis found in other cases with Menetrier's disease. A 14 day antibacterial treatment course with 750 mg amoxicillin three times a day combined with 40 mg omeprazole three times a day was started in April 1991. This resulted in eradication of H pylori and the return to normal of giant folds and the mucosal histology. Serum protein concentrations returned to normal within six weeks and remained normal at two endoscopies during a two year follow up. This case report suggests that a subgroup of the patients with Menetrier's disease may be healed by the eradication of H pylori.