Menetrier Disease

Michael P. Federle, MD, FACR

Key Facts

Imaging

Rare condition of unknown cause
UGI: Grossly thickened, lobulated folds in gastric fundus and body with poor barium coating
CECT: Massive thickening of mucosa and submucosa
- Engorged gastric arteries and veins
- No extension into perigastric tissues
Histology: Marked foveolar hyperplasia (mucin production) → protein loss → hypoproteinemia
- Atrophy of acid-producing cells → hypochlorhydria

Top Differential Diagnoses

Gastritis
Zollinger-Ellison syndrome
Gastric metastases and lymphoma
Gastric carcinoma

Clinical Issues

Bimodal age distribution
- Children (usually boys)
- Has been associated with Cytomegalovirus infection
Adults (mean age 55 years)
- Prolonged illness in most adults
Complications
- Gastric carcinoma may have ↑ prevalence (controversial)
- Increased risk of deep venous thrombosis (DVT)
- Risk of atrophic gastritis, gastric ulcer, GI bleeding
Medical therapy: Anticholinergic agents, antibiotics, prostaglandins
- High-protein diet
May require total gastrectomy

(Left) Film from an upper GI series shows massive fold thickening throughout the gastric fundus and body, with relative sparing of the antrum. Also noted is poor coating of the mucosa by the barium. (Right) 68-year-old woman with proven Ménétrier disease. CECT shows grossly thickened folds