Clinical Presentation

A 63-year-old man with end-stage renal disease presents with midepigastric pain.

(A) Upper gastrointestinal barium study shows diffusely thickened rugal folds (arrows) despite adequate distension. (B) Contrast-enhanced computed tomography (CT) shows thickened rugal folds (arrow) and atrophic kidneys (arrowheads) with cysts.

Differential Diagnosis

• Chronic gastritis from renal failure: This is at the top of the list because of the history of renal failure and diffuse, uniform gastric fold thickening.

• Gastritis ( Helicobacter pylori ): This is second as this entity is the most common cause of rugal fold thickening.

• Ménétrier disease: Expect hypersecretion and possible antral sparing, both present in this case.

• Zollinger-Ellison syndrome: Expect hypersecretion, small-bowel involvement, and evidence of gastrinoma.