Menetrier's disease associated with formula protein allergy and small intestinal injury in an infant

Malabsorption Syndromes and Food Intolerance

Feeding intolerance is ubiquitous in neonatal intensive care units with as many signs and symptoms as possible diagnoses. Optimizing nutrition is paramount in both preterm and term infants. Determining the cause of feeding intolerance and adjusting nutrition interventions is an important part of the daily care of newborns. This review discusses the role of malabsorption and food intolerance as possible causes of nutrition difficulties in the newborn.

Diagnosis and Management of Ménétrier Disease in Children: A Case Series Review

PURPOSE

Ménétrier disease (MD) was first described in 1888, and 50 cases have been reported until now. We aimed to discuss the etiology, diagnostics, and management of MD in children.

METHODS

We searched for case reports published from 2014 till 2019 in English using PubMed. Articles were selected using subject headings and key words of interest to the topic. Interesting references of the included articles were also included.

RESULTS

The pathophysiology of MD is still uncertain. However, overexpression of transforming growth factor alpha with transformation of the gastric mucosa has been observed, which may be mediated by genetics and provoked by an infectious trigger. Clinically, MD is diagnosed by abdominal pain, vomiting, anorexia, and edema secondary to hypoalbuminemia. A gastroscopy with biopsy is the gold standard for the diagnosis of MD. In children, the disease is self-limiting and only requires supportive treatment. In general, children have a good prognosis and recover spontaneously within a few weeks.

CONCLUSION

Few pediatric cases of MD have been described in recent years, and with all different etiology. Endoscopy with biopsy remains the golden standard for the diagnosis of MD, and in children, the disease is self-limiting.

Menetrier's disease associated with Helicobacter pylori: three cases with sonographic findings and a literature review

Menetrier's disease is a rare cause of protein-losing gastropathy characterised by hypertrophy of the gastric folds. Three cases are reported. Helicobacter pylori was detected by culture and CLO test in two cases and on follow-up gastroscopy in the other. The first two patients were given eradication therapy and hypertrophic gastropathy resolved whereas in the third the disease remitted prior to the eradication treatment. Typical sonographic features were thickened gastric wall with preservation of the wall stratification. A review of the literature found eight cases of Menetrier's disease associated with H. pylori in children and these cases are briefly reviewed. H. pylori infection should be considered in all children with Menetrier's disease and, if isolated, eradication treatment should be administered.

Doença de Ménétrier: relato de caso em menina

OBJETIVO: Relatar um caso de menina com doença de Ménétrier. DESCRIÇÃO DO CASO: Menina de dez anos, admitida com história de vômitos, diarréia, distensão e dor abdominal intermitentes há três dias. A suspeita foi apendicite e a paciente foi submetida à laparotomia, com achado de ascite e adenomegalia mesentérica. No pós-operatório, evoluiu com edema generalizado, ascite e derrame pleural. Os exames complementares e a evolução clínica demonstraram tratar-se de doença de Ménétrier. COMENTÁRIOS: O quadro clínico e os exames solicitados (alfa-1-antitripsina fecal aumentada, mucosa gástrica tipo fúndica com moderado grau de hiperplasia do epitélio luminal e foveolar e seriografia com hipertrofia do pregueado mucoso gástrico) confirmaram a doença de Ménétrier.

Foveolar hyperplasia secondary to cow's milk protein hypersensitivity presenting with clinical features of pyloric stenosis

Pyloric stenosis is one of several causes of infantile nonbilious vomiting. A 7-week-old boy presenting with symptoms suggestive of this was found to have a prepyloric lobular mass causing near-complete gastric outlet obstruction. The histology showed localized hypertrophic gastropathy with hyperplasia and tortuosity of foveolar cells reminiscent of Menetrier changes. Postsurgical excision, the child continued vomiting until removal of bovine and soy proteins from his diet. The clinical presentation, pathology, and response to restrictive diet suggested cow's milk protein allergy as key. The literature describing infantile focal foveolar hyperplasia and Menetrier disease is reviewed, stressing the rarity of allergy as cause.

High-resolution real-time compound ultrasound imaging of transient protein-losing gastropathy of childhood

We report the case of a 1.5-year-old girl with transient protein-losing gastropathy with hypertrophic gastric folds (PLGH). The diagnosis of PLGH was made by abdominal ultrasound (US) and not by an upper gastrointestinal (UGI) study as reported in many previous publications. Real-time compound ultrasound imaging showed in high detail the echogenic thickening of the mucosal gastric layer and associated hyperaemia on colour Doppler US. These ultrasonic findings highly correlated with the endoscopic US findings and microscopic changes of the gastric wall in PLGH. An awareness of the high-resolution abdominal ultrasound appearances of PLGH may facilitate earlier diagnosis and obviate the need for an upper GI contrast series.