P2830 - Malnutrition Due to a Rare Condition: A Case of Ménétrier’s Disease

Timothy Graziano, DO, Neil Patel, DO, William Ghaul, DO, Preysi Patel, DO
Lehigh Valley Health Network, Allentown, PA

Introduction: Ménétrier’s disease is an exceedingly rare form of gastric mucosal hypertrophy with less than 1000 documented cases in literature. Clinical manifestations include weight loss and edema due to severe hypoalbuminemia; however, nonspecific endoscopic findings commonly lead to misdiagnosis of other entities. Here, we present an uncommon case of anasarca due to Ménétrier’s disease.

Case Description/Methods: A 64-year-old female with a history of deep vein thrombosis on warfarin therapy presented with progressive bilateral lower extremity edema refractory to furosemide. Associated symptoms included abdominal cramping with loose stools and an unintentional 50-pound weight loss over several months. Labs were notable for an albumin of 0.9 g/dL and total protein of 4.7 g/dL. Celiac and stool panels were normal. Endoscopic evaluation showed atrophic gastritis with hyperemic and abnormally enlarged rugal folds. Gastric biopsies, interestingly, demonstrated evidence of massive foveolar hyperplasia with atrophic oxyntic mucosa. A diagnosis of Ménétrier’s disease was made based upon the combination of laboratory and pathological findings. The patient was managed supportively with a high-protein diet and micronutrient replacement.

Discussion: Initially described in 1888, Ménétrier’s disease is a hypertrophic gastropathy that may cause complications including gastric outlet obstruction and critical malnutrition. Disease pathophysiology likely involves an underlying genetic predisposition driving an overexpression of epidermal growth factor receptors within gastric mucosa. Signs and symptoms are variable and may mimic other disease states, including chronic gastritis, gastric cancer, and lymphoma. Therefore, histopathologic findings of gastric foveolar hyperplasia and oxyntic gland atrophy are crucial for differentiation. Treatment has yet to be standardized but typically involves proton pump inhibitor therapy, high-protein diet, and surgery in severe refractory cases. Though rare, Ménétrier’s disease deserves greater understanding and awareness given the potential of misdiagnosis and severe complications as seen in our case.


Disclosures:


Timothy Graziano, DO, Neil Patel, DO, William Ghaul, DO, Preysi Patel, DO. P2830 - Malnutrition Due to a Rare Condition: A Case of Ménétrier’s Disease, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.