Spontaneous Remission of Protein-Losing Gastropathy Associated with Menetriers Disease; A Plea for Conservative Management

Abstract

Spontaneous remission of the protein-losing gastropathy of Menetrier’s disease occurred after four months of disease activity. Because the natural history and cause of Menetrier’s disease is unclear, we suggest a more conservative approach to the management of this condition, despite recent publications to the contrary.

Case Details

Personal Characteristics

A 58-year-old man

Clinical Characteristics

Edema of the legs, watery diarrhea without blood or mucus, no fever, swelling of the legs, weight gain of 8 kilograms, normal physical examination except for edema of the legs, normal urinalysis results, normal hemoglobin level, normal electrolytes, normal bun level, normal liver function test results, albumin content was 2.0 gm/dl, normal xylose absorption and results of schilling tests, hypertrophic gastric mucosa with a suspicion of an infiltrating neoplasm, gastric juice contained large amounts of protein, mucosal hypertrophy and inflammation, pathological changes typical of menetriers disease

Remission Characteristics

Serum albumin level rose to 4.0 gm/dl, peripheral edema disappeared, sharp decrease in the gastric protein concentration, polyvinyl pyrolidone excretion was decreased, remission maintained during 18 months of follow-up, return to within normal limits of the roentgenographic findings

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Laparotomy, gastroscopy with multiple biopsies, high protein diet, regular diet

Additional Notes

Spontaneous remission of the protein-losing gastropathy of Menetriers disease occurred after four months of disease activity. Because the natural history and cause of Menetriers disease is unclear, we suggest a more conservative approach to the management of this condition, despite recent publications to the contrary.