Menetrie disease - A rare pathology of the stomach, which is manifested by a pronounced thickening of the gastric mucosa, changes in the glands, and the thickness of the folds exceeds 2-3 cm. The etiology of this disease has not been established. For the purpose of diagnosis, a detailed study of the patient's complaints, the identification of hypoalbuminemia, and specific signs during gastric X-ray and fibrogastroscopy are carried out. Treatment consists of the use of astringent, enveloping drugs, in the case of complicated forms, surgical treatment is carried out. Giant hypertrophic gastritis can last for decades, in some cases, the pathology regresses to simple atrophic gastritis. In such cases, the prognosis is favorable.
Causes of Menetria disease
The causes of the disease have not been established. A certain role in its origin is given to errors in nutrition, low intake of vitamins, chronic lead intoxication, alcoholism, certain infectious diseases, genetic, neurogenic factors. Proved the presence of sensitization to food allergens, which causes an increased permeability of the gastric mucosa.
Currently, several main theories of the development of Menetria disease are considered in gastroenterology: a consequence of an inflammatory lesion of the mucous membrane, the result of abnormalities in the development of the stomach, a benign tumor process. The role of transforming growth factor alpha (TGF alpha) in the pathogenesis of the disease has been proven. It enhances the production of mucus by the glands of the stomach and reduces the secretion of hydrochloric acid.
Symptoms of Menetria disease
Clinical symptoms of the disease develop gradually. The most common symptom is pain in the epigastric region. Pain syndrome can have different duration and severity, more often pains are aching, occur after eating and are combined with a feeling of heaviness in the stomach. Vomiting, diarrhea, gastric bleeding occur.
An important diagnostic feature is weight loss. For a fairly short period of time, the patient can lose up to 10-20 kg without changing his eating habits. In rare cases, there is a decrease in appetite. Perhaps the appearance of peripheral edema, which is caused by a decrease in the content of proteins in the serum.
A number of specialists define Menetria disease as a precancerous disease, bearing in mind the incidence of adenocarcinoma of the stomach against the background of hypertrophic gastritis, which reaches 10-20%. But other gastroenterologists question this data, since many studies on this disease have not proved histological confirmation of the causal relationships of adenopapillomatosis and gastric cancer.
Pathology can exist for a long time, flowing with periodic exacerbations and long-term remissions. In some cases, there is a decrease in symptoms and the transition of the disease to the atrophic form of gastritis (atrophic gastritis).
Diagnosis of Menetria disease
Diagnosis begins with a detailed study of patient complaints over time. Since the disease can be asymptomatic for a long time, it is important to ascertain the slightest changes in health, weight, nutrition.
In blood tests, a decrease in the number of erythrocytes, hemoglobin, is determined. This is due to frequent blood loss, but rarely severe anemia. In some cases, marked leukocytosis with a neutrophilic shift. Biochemical blood tests reveal a decrease in albumin levels. This is due to the fact that proteins are lost due to increased mucosal permeability. This fact is confirmed by studies using intravenous labeled albumin. In determining the acidity of gastric juice, a hypoacid state is noted.
An important diagnostic method for adenopapillomatosis is gastric X-ray, revealing the characteristic features: marked thickening of the folds of the gastric mucosa locally or over the entire area. When contrasting the stomach with a tight filling with a contrasting mixture, greatly enlarged folds can give a picture of a filling defect characteristic of oncological pathology. But with hypertrophic gastritis there is no breakage of the folds, they have a specific location. In this case, the walls of the stomach retain elasticity, sufficient peristalsis is determined by both curvatures. With further filling of the stomach with contrast folds fold, which allows to distinguish this pathology from stomach cancer.
A characteristic picture of the modified mucosa allows you to identify endoscopic examination - fibrogastroscopy. When inspecting the mucous membrane with the help of fiber optics, a significant thickening of the folds, which take the form of “cobblestone pavement”, is determined, their puffiness, pallor, less often - hyperemia. Mucous membrane, in the upper folds of the folds are often eroded. The folds are mainly located in parallel, less often chaotic. Their height is more than two centimeters. Rarely the total number of folds can be increased, in most cases, it is kept within the normal range. When conducting FEGDS, air inflation is used, and folds are considered gigantic, which do not smooth out when a pressure of 15 mm Hg is reached. Art.
The aiming biopsy is performed for the purpose of differential diagnosis with malignant neoplasms. The histological picture characteristic of Menetrie’s disease is not detected with this type of biopsy, since the altered glands are not included in the surface material taken.
To identify their changes, a biopsy of deep areas of the mucous is performed with the capture of the layers in which the glands are located. This allows you to confirm the disease histologically. However, the diagnostic errors of such a biopsy are higher, since taking the material “blindly” (without endoscopic control) does not always allow taking the material from the modified area. Due to the complexity of the histological confirmation, a diagnosis can be made by monitoring the patient over time, as well as repeated X-ray diagnostics and endoscopy.
Treatment of Menetria disease
The treatment of this pathology is carried out by a gastroenterologist. Be sure to follow a sparing diet rich in protein. Meals should be prepared taking into account their thermal, chemical and mechanical neutrality for the mucous. Sharp, fried foods, and eating too hot or cold are not recommended.
Non-severe forms involve conservative therapy. Enveloping, binding agents that protect the gastric mucosa are prescribed. If necessary, substitution of the acid-forming function deficit is carried out. The use of anticholinergic agents (atropine) contributes to the reduction of protein loss, as well as to the subjective improvement of well-being.
In severe cases of giant hypertrophic gastritis, accompanied by severe persistent pain, frequent bleeding, development of edema due to protein deficiency, surgical treatment is performed - gastrectomy. This method is also applicable in situations where a malignant neoplasm cannot be excluded. Patients with this diagnosis are subject to follow-up, the control X-ray and FGDS are held every six months. This allows you to correctly assess the dynamics of the disease.
Prediction and prevention of Menetria disease
The course of this disease may be different. Most often, symptoms persist for many years, but regression to atrophy is possible with restoration of serum albumin. The fact that adenopapillomatosis is associated with gastric adenocarcinoma has not been proven. In uncomplicated forms, the course of the disease depends largely on dieting, and not only during exacerbations, regular examinations with the aim of timely detection of complications. Since the etiological factor of this pathology has not been established, there is no specific prophylaxis.
The etiological factors and the mechanism of the development of Menetrie’s disease are not well understood. It is believed that the causes of changes in the gastric mucosa can be chronic intoxication (alcohol, lead), nutritional errors, hypovitaminosis, infectious diseases (viral hepatitis, dysentery, typhoid fever), metabolic disorders, neurogenic and hereditary factors, smoking. A special place in the development of the disease divert the increased sensitivity of the body to food allergens, which leads to an increase in the permeability of the gastric mucosa. It is possible that the disease is a consequence of abnormal development, inflammation in the gastric mucosa, or manifested as a variant of a benign tumor.
Macroscopic examination reveals a characteristic thickening of the folds of the gastric mucosa, the height of which is at least 2-3 cm. Changes in the mucous membrane, most pronounced in the region of the greater curvature of the stomach, are most common (in some cases limited). Microscopic examination shows edema and a decrease in the number of main and occipital cells, some of which are replaced by mucus-forming cells. The mucus-forming cells are enlarged, the secretion of mucus is increased. This helps to increase the gastric glands (some of them penetrate into the muscle layer), followed by their transformation into cysts.
Menetrie disease is most often recorded at the age of 30-50 years (the ratio of men and women is 3: 1), but can also occur in childhood. The disease in most cases develops gradually, but sometimes an acute onset is recorded. The most common symptoms are abdominal pain, significant weight loss, vomiting, loose stools, repeated stomach bleeding. Pain occurs after eating, accompanied by a feeling of fullness and heaviness in the stomach and localized in the epigastric region. In some patients, at the height of the attack of pain, vomiting occurs first, and then diarrhea. Appetite reduced. Patients can lose up to 10-20 kg of weight. Disturbance of gastric juice secretion (reduced production of hydrochloric acid, loss of protein with gastric juice due to increased permeability of the gastric mucosa) and a significant decrease in appetite contribute to the development of peripheral edema. Gastric bleeding in the majority of patients is not heavy and in rare cases can cause severe anemia. There is a moderate decrease in the number of erythrocytes and hemoglobin, neutrophilic leukocytes in the blood, the number of platelets and ESR correspond to age indicators. Currently, in Menetria disease, depending on the severity of the symptoms of the disease, there are three options for the course - dyspeptic, pseudo-tumor and asymptomatic. Possible long-term course of Menetria disease with periods of prolonged remission. In some patients, there has been a gradual (for many years) subsidence of the clinical manifestations of the disease, followed by the transformation of the disease into chronic atrophic gastritis. It is possible that Menetria’s disease is a precancerous condition.
The diagnosis of Menetrie’s disease is made on the basis of the patient’s examination data obtained under continuous observation and the results of additional research methods (X-ray, endoscopic, targeted biopsy).
X-ray examination allows to identify changes characteristic of Menetrie’s disease. There are common and limited forms of anomaly. With a limited form of the disease, Menetria has a collection of thick sinuous folds that protrude significantly into the lumen of the stomach and constitute a filling defect of irregular shape, consisting of "pillow" formations. A typical localization of the accumulation of folds in this disease is a large curvature opposite the angle of the stomach. In the common form, such changes in the gastric mucosa are determined over a large distance with a predominance in the arch, body and sinus of the stomach. At the same time, normal folds are revealed in the antrum. The location of the folds with limited and common forms preserves a certain order. The walls of the stomach retain elasticity, peristalsis is recorded both along the minor and along the greater curvature.
Endoscopic examination is important in the diagnosis of Menetria disease. The endoscopic picture of this disease is characterized by the presence in the body of the stomach along the greater curvature of sharply thickened folds of the mucous membrane, which have the appearance of "cerebral gyri" or "cobblestone pavement". Folds in most cases are pale and edematous, sometimes blood-filled, there may be numerous erosions on the tops of the folds. The method of dosed inflating of the stomach with air during endoscopic examination makes it possible to reveal giant folds that do not decompose when the pressure in the stomach is more than 15 mm Hg. Art. Using the method of aspiration biopsy, large sections of the mucous membrane are collected for tissue examination. Tissue study confirms the presence of enlarged gastric glands and cysts.
Menetries disease should be differentiated from hypertrophic gastritis, gastric polyps and common familial polyposis of the gastrointestinal tract (Peutz-Touraine-Jeghers syndrome, Kronkhayta-Canada syndrome), Zollinger-Ellison syndrome, gastric lesions in tuberculosis and syphilis, benign and malignant tumors of the stomach. The greatest difficulty is the differential diagnosis of Menetria disease from gastric cancer. In doubtful cases, it is recommended to re-examine the patient in 1–1.5 months or immediately conduct a trial laparotomy, so as not to miss the malignant process.
In case of Menetries disease, conservative and surgical treatment methods are used. Conservative therapy includes a mechanically and thermally sparing diet with a high content of the protein component, the use of enveloping and astringent preparations. According to the testimony, replacement therapy is recommended: natural gastric juice, plantaglucid, abomin, 1% hydrochloric acid solution with pepsin, polizim, mexase, panzinorm. An improvement in the patient’s general condition and a decrease in protein loss is noted with the use of anticholinergic drugs at age dosages. All patients should be at the dispensary and twice a year to undergo a control X-ray and endoscopic examination. In the absence of the effect of conservative treatment, the presence of complications (persistent pain syndrome, edema, repeated gastric bleeding), the inability to exclude a malignant neoplasm, complete or partial gastrectomy is performed followed by tissue research.
Anatomy of the stomach in hypertrophic gastritis
In hypertrophic gastritis, the gastric mucosa thickens.
The mucous membrane of the stomach with this disease thickens, its folds reach a height of more than 3 centimeters.Localization of such manifestations is most often located in the region of the greater curvature of the stomach.
Wrinkling hypertrophy is rarely limited, in many cases the changes affect a large part of the mucous membrane.
The main and occipital cells become smaller, and the mucus-forming cells increase the production of mucus and increase in size themselves. As a result, the gastric glands increase in size and turn into cysts. Multiple cysts lead to polyadenomatosis.
The folds of the mucous membranes are focal inflammatory process. The stomach lining becomes permeable to gastric juice and protein. When the inflammatory process moves to the vessels of the mucous membrane, gastric bleeding appears.
Metabolic disorders can cause hypertrophic gastritis.
The insufficiently studied pathology makes it impossible to establish the exact causes of the occurrence of Menetria disease. The alleged causes of hypertrophic gastritis:
- Metabolic disorders.
- Intoxication with alcohol, nicotine and industrial hazards (lead).
- Lack of vitamins in the diet.
- Consequences of infections (hepatitis, dysentery, typhoid fever).
- Factors of heredity.
- Hypersensitivity to food allergens.
- Anomalies of development at the stage of the embryo.
- The consequences of the inflammatory process of the gastric mucosa.
- Tumor benign character.
For more information about gastritis with hypertrophy of the mucous membrane, see the video:
Clinic of the disease
The main age category of patients suffering from this type of gastritis - men and women from 30 to 50 years, and this ratio by gender is distributed as 3: 1.
The disease progresses slowly, periods of exacerbation alternate with periods of prolonged remission.
In some patients, the clinic manifestations of this disease subsides, moving to the clinical manifestations of atrophic gastritis, becoming a precancerous condition. Symptoms of giant gastropod gastritis:
- Pain in the epigastric region after a meal, have a different duration and intensity.
- The feeling of heaviness and distention in the stomach.
- Diarrhea, vomiting.
- Loss of appetite and a sharp weight loss associated with this symptom (10–20 kg), turning into anorexia in advanced cases.
- Peripheral edema due to protein loss.
- Inadequate stomach bleeding, anemia.
Laboratory studies of the blood of a patient with Menetria’s disease may show a slight decrease in neutrophilic leukocytes, hemoglobin, and red blood cells. It is possible that the disease will be asymptomatic.
Like the reasons, not fully understood. It has been established that folds of the gastric mucosa are hypertrophied with this disease. The height of the folds can reach 3 cm.
The main and occipital cells producing gastric co and hydrochloric acid atrophy. But the number of mucus-forming cells, and, accordingly, gastric mucus increases.
In this case, the gastric glands increase in size, and can grow into the deeper layers of the gastric wall — into the muscular and submucosal.
Over time, multiple cysts form at the site of hypertrophic glands - polyadenomatosis develops.
In the hypertrophied folds themselves there is a focal inflammatory process. This increases the permeability of the mucous membrane for protein and gastric juice. In some cases, the blood vessels of the mucous membrane are involved in the inflammatory-degenerative process, which can cause bleeding.
The peak incidence of hypertrophic gastritis falls on the age group from 30 to 50 years, and men are sick 3 times more often than women. The disease develops gradually, and is chronic.
Patients complain of aching pain in the projection of the stomach, in the epigastric region. The decrease in the production of hydrochloric acid and gastric juice leads to dyspepsia (indigestion), manifested by abdominal distention, nausea, vomiting.
Sometimes vomiting takes on the color of coffee grounds. This suggests that hypertrophic gastritis was complicated by bleeding.
True, the bleeding at the same time small, and rarely pose a threat to life. However, anemia (anemia) in this disease is quite common. It is caused by a deficiency of protein and iron as plastic materials for hemoglobin and erythrocytes.
Constant deficiency of protein further leads to a decrease in the oncotic pressure of blood plasma and to the appearance of protein-free edema. When running forms of the disease, patients complain of lack of appetite, there is pallor of the skin, weight loss.
For this reason, Menetries disease is often mistaken for stomach cancer. At the same time, it has been established that hypertrophic gastritis is a precancerous condition, and in fact it can be complicated by a malignant tumor - adenocarcinoma of the stomach.
Diagnosis and treatment
The diagnosis is confirmed during gastroscopy. At the same time, hypertrophied folds of the mucous membrane (a symptom of a cobblestone pavement, brain convolutions) with foci of inflammatory infiltration, erosions and cysts are clearly visible. During the study, a biopsy is performed - a histological examination of these lesions on the subject of stomach cancer.
Conservative treatment includes painkillers, antispasmodics, digestive enzymes, fortifying agents, vitamins. With reduced or zero acidity, a 1% solution of hydrochloric acid is prescribed, natural gastric juice.
Stimulation of self-secretion of gastric juice in this disease is ineffective. For these patients, a protein rich diet is recommended.
Severe pain, frequent bleeding, high risk of malignant neoplasms - all this serves as an indication for surgery, full (gastrectomy) or partial (resection) removal of the stomach.
Treatment of the disease
Panzinorm - increases the acidity of gastric juice.
Despite the fact that no more than 300 patients are described in the medical literature today, gastroenterology has accumulated sufficient experience for stopping the symptoms of the disease.
Patients with Menetrie’s disease should be registered at the dispensary and be repeatedly examined by hardware methods.
A diet with this pathology is an indispensable condition for effective treatment. It should be gentle, not aggravate the condition of the damaged gastric mucosa. Spices, spicy, fatty, fried food with this disease for the patient is under strict prohibition.
Since the loss of proteins through the gastric mucosa is one of the symptoms of this disease, a large number of easily digestible proteins are included in the menu. The regularity of meals and its temperature - an important component of the diet. Food should be only warm, not irritate mucous membrane damaged by ulcers.
Food components should not be too rough, some dishes can be taken in a shabby form. The mucous soups and porridges enveloping a mucous membrane are useful. Conservative treatment in addition to the diet includes the following drugs:
- Knitting and enveloping agents.
- Digestive enzymes.
- Restorative means.
- Substitutes that increase the acidity of gastric juice (Panzinorm, Plantaglyukid, natural gastric juice, Polizim, Abomin, Mexase, 1% solution of hydrochloric acid with pepsin).
- Anticholinergic drugs.
If the diagnosis showed the presence of ulcers of the mucous membrane, treatment is carried out, similar to the same treatment for ulcers of the stomach. With an unfavorable prognosis for the development of the disease and the persistent manifestation of complications (swelling of the extremities, gastric bleeding, epigastric pain), surgery is performed - gastroectomy. Possible complications of Menetria disease:
- Malignant degeneration of the mucous membrane (malignancy).
- Gastric bleeding.
- Chronic pain syndrome.
Vomiting as one of the symptoms
Since the causes of the disease are not identified with complete certainty, it is impossible to take adequate preventive measures. It is advisable to avoid bad habits, maintain the body’s immune defenses at a high level, and follow a rational diet.
For patients with this type of gastritis, optimal prevention of relapses will be timely visits to the doctor, following his recommendations, regular diagnostic procedures.
Menetries disease is a rare inflammatory disease of the stomach, when its mucosa is overly developed, hypertrophied into giant folds. The causes of this pathology are not well understood, diagnostic methods allow us to determine the exact diagnosis and prescribe adequate treatment.
In children, Menetries disease is extremely rare, it is uneventful, and responds well to treatment. In adults, complicated forms of the disease that are not amenable to drug therapy lead to surgical intervention.
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