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

Future candidates for indications of Helicobacter pylori eradication: do the indications need to be revised?

Since the discovery of Helicobacter pylori in 1982, the development of several treatment guidelines has allowed a consensus on the indications for H. pylori eradication. Beyond these currently accepted indications, including various upper gastrointestinal disorders and extragastric diseases, a significant amount of new information regarding H. pylori eradication is emerging. Certain types of acute gastritis, such as nodular gastritis, hypertrophic gastritis, Ménétrier's disease, hemorrhagic gastritis, and granulomatous gastritis are reversible after H. pylori eradication. Further, for chronic gastritis, closed-type atrophic gastritis and complete-type intestinal metaplasia appear to be more reversible after H. pylori eradication than open-type atrophic gastritis and incomplete-type intestinal metaplasia. Eradication can also be considered in subjects younger than 40 years who have a family history of gastric cancer and in subjects with long-term medications that might lead to bleeding (antiplatelet agents) or atrophy (proton pump inhibitors). Emerging evidence indicates that H. pylori eradication could be an effective treatment for some extragastric diseases that are unresponsive to conventional therapy. In such conditions, routine screening for eradication of H. pylori has not previously been recommended; a "test-and-treat" approach is suggested in the aforementioned situations. Given that H. pylori eradication is effective when the gastritis is reversible, future indications should be expanded to include acute gastric lesions that show marked improvement upon H. pylori eradication rather than just focusing on chronic gastric lesions. Future indications for H. pylori eradication should focus more on reversible lesions before preneoplastic conditions develop.

Protein-losing gastropathy with hypertrophic gastric folds: endosonographic findings

We present a case of protein-losing gastropathy with hypertrophic gastric folds. A 38-year-old man was hospitalized for severe epigastric pain suggestive of hypoproteinemia. Endoscopic and radiologic examination revealed enlarged gastric folds on the greater curvature of the stomach. Endoscopic sonography revealed marked thickening of the second layer on the greater curvature of the stomach. Endoscopic mucosal resection was performed, and the diagnosis was hypertrophic gastritis. After prednisolone treatment, hypoproteinemia and the enlarged gastric folds of the stomach resolved.

[Ménétrier's disease of childhood and acute cytomegalus virus infection]

Menetrier's disease of childhood, or protein-losing hypertrophic gastropathy, is a rare entity of unknown etiology, characterized by hypertrophy of the gastric mucosa as well as secondary protein loss. Most published cases are associated with infection, mainly viral. These infections could alter the factors regulating growth and the function of gastric cells. In children, the disease is mild and resolved within a few weeks. We present the case of a 15-month-old child with a 72-hour history of intractable vomiting, hypoproteinemia and generalized progressive edema. We describe the characteristics of this case, as well as the clinical, ultrasonographic and endoscopic findings required for a diagnosis of this disease.

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.

Utilization of knockout mice to examine the potential role of gastric histamine H2-receptors in Menetrier's disease

Menetrier's disease is characterized by giant gastric folds with foveolar hyperplasia and cystic dilatation, hypoproteinemia, and enhanced mucus secretion. The etiology remains unresolved and an effective treatment has yet to be established. Here we show that histamine H(2)-receptor deficient mice developed gastric pathophysiological changes resembling Menetrier's disease for up to 17 months of observation. Mutant mice were found to have an increased stomach weight, enlarged gastric folds with cystic dilatation, hypergastrinemia, hypoalbuminemia, increased mucus secretion and overexpression of mucosal transforming growth factor (TGF) alpha. Both a cholecystokinin (CCK)(2)-receptor antagonist and an epidermal growth factor (EGF)-receptor tyrosine kinase inhibitor significantly reduced the increase in stomach weight. It appears that lack or downregulation of histamine H(2)-receptors might be involved in the pathogenesis of Menetrier's disease.

Ménétrier's disease associated with ulcerative collitis

In this paper a 21 year old patient was presented with M?n?trier's disease, associated with ulcerative colitis. The first symptoms of ulcerative colitis occured at the age of eleven, since when the patient has been conservatively treated several times because of the exacerbations of the desease. During control examinations presence of polipoid changes in stomach was discovered by upper endoscopy. Gastrectomy was suggested because the patient had excessive anemic syndrome which required weekly substitutional therapy with deplasmatic eritrocytes, as well as hypoproteinemia, while multiple polipoid changes suspect for malignancy were gastroscopically identifided. Patient accepted surgical treatment, and was transfered to the Clinic of Surgery. Total gastrectomy was performed, and patohystological finding confirmed M?n?trier's desease. After two weeks, the patient was released from the hospital in good general condition, with regular clinical and laboratory findings.