Ménétrier disease

Overview

Ménétrier disease causes the ridges along the inside of the stomach wall—called rugae—to enlarge, forming giant folds in the lining of the stomach. The rugae enlarge because of an overgrowth of surface mucous cells of the stomach. In a normal stomach, rugae release protein-containing mucus. Enlarged rugae release too much mucus, causing a leakage of protein from the blood into the stomach. This shortage of protein in the blood is known as hypoproteinemia. Ménétrier disease also causes a decrease in stomach acid resulting from a reduction in acid-producing parietal cells.

Symptoms

Possible signs and symptoms of Ménétrier disease include * severe pain in the top middle part of the abdomen * nausea and frequent vomiting * swelling of the face, abdomen, limbs, and feet * loss of appetite * extreme weight loss * malnutrition * low blood protein * anemia * diarrhea

Causes

What causes Ménétrier disease is unclear; however, it is thought to be an acquired disorder with no known genetic component. Recent studies suggest people with Ménétrier disease have stomachs that make abnormally high amounts of a protein called transforming growth factor-alpha (TGF-α). Growth factors are proteins in the body that tell cells what to do, such as grow larger, change shape, or divide to make more cells. A cause for the overproduction of TGF-α has yet to be found.

Diagnosis

Ménétrier disease is diagnosed through x rays, endoscopy, and biopsy of stomach tissue. Endoscopy involves looking at the inside of the stomach using a long, lighted tube inserted through the mouth. During a biopsy, the doctor removes a small piece of tissue and examines it with a microscope for signs of disease.

Treatment

Treatment may include medications to relieve nausea and pain. A high-protein diet is prescribed to offset the loss of protein from enlarged rugae. Part or all of the stomach may need to be removed if the disease is severe. The anticancer drug cetuximab (Erbitux) blocks the action of TGF-α and is being investigated as a promising new treatment for Ménétrier disease.