Transient protein-losing gastropathy (Menetrier's disease) in childhood

Abstract

Two cases of transient protein-losing gastropathy (PLG) or Menetrier's disease in childhood are described. Both cases presented with an abrupt onset of edema due to hypoalbuminemia and were diagnosed by an upper gastrointestinal series. One of the cases was further diagnosed and followed by ultrasound. We believe that this is the first description of the ultrasonic picture of transient PLG in children. In both cases complete recovery was evident after a few weeks.

Childhood Ménétriér′s Disease: A Rare Cause of Exudative Enteral Protein Loss

“…The diagnosis of Ménétriér's disease was based on the presence of giant hypertrophy of gastric folds seen both radiologically and at endoscopy, hypoalbuminemia with associated enteral protein loss and a histological gastritis that is often associated with hypochlorhydria. As has been previously reported in children with Ménétriér's disease, this patient's clinical course was self-limited and benign (2)(3)(4)(5)(6)(7)(8)(10)(11)(12)(13). Although the microscopic appearance of his fundal biopsy was not classical of this disorder (there was no evidence of foveolar hyperplasia and atrophied glands), there was tissue eosinophilia and edema which is seen histologically in this disease.…”

“…It was first described by Ménétriér in 1888 (1), and since its initial description there have been only 47 pediatric cases reported (2). The disorder is characterized by an enlargement of gastric rugal folds and characteristic histological changes in full thickness biopsy specimens, and is often associated with hypochlorhydria, hypoproteinemia and edema (2)(3)(4)(5)(6)(7)(8)(9)(10). Compared with the adult form of Ménétriér's disease, which follows a chronic pattern often requiring active treatment, the childhood form is usually self-limited.…”

High-resolution real-time compound ultrasound imaging of transient protein-losing gastropathy of childhood

“…In the literature, a UGI examination is usually the radiological examination of choice to visualize thickened gastric folds in suspected PLGH [2,7,8,9,10,11]. In the present case, transabdominal sonography made the initial diagnosis of PLGH by state-of-the-art crosssectional compound imaging of an abnormal gastric wall.…”

Sonographic appearance of Ménétrier's disease in a child.

“…6 .7 With knowledge of the clinical data, the diagnosis of Mene· trier's disease can be made sonographically with confidence. Should follow-up examination demonstrate a regression of the mucosal thickening, the patient can, in uncomplicated cases, be spared biopsy or x-ray examination.…”