Menetrier Disease: A Nephrotic Syndrome of the Stomach

Abstract

Menetrier Disease (MD) is a rare acquired disease that affects middle-aged men in their mid 40's and, to a lesser extent, women and children. Pierre Eugene Menetrier first described it. It is a premalignant disorder, sometimes associated with Helicobacter Pylori in adults, and Giardia lamblia and Cytomegalovirus in children. The enlargement of the rugae folds is due to increase production of transforming Growth Factor-α (TGF-α) ligand, which subsequently activates epidermal growth factor receptor (EGFR) that stimulate the proliferation (hyperplasia) of the mucosal epithelium. Glandular dysfunction and protein leaks into the stomach result in anemia, hypoproteinemia, and edema. These are distinguishing characteristics of the pathology. Diagnosis is made by barium esophagogram, esophagogastroduodenoscopy (EGD), and serology. A monoclonal antibody called cetuximab (anti-EGFR) is the first treatment for Menetrier disease. Other supportive therapies are regimens for peptic ulcer disease, proton pump inhibitors, anticholinergic drugs, steroids, a high-protein diet, and gastrectomy. Prognosis is better for children than adults because of higher risk of developing gastric cancer. The review article aims to discuss this rare gastric mucosa (foveolar) disorder called Menetrier and support integration, research and learning among medical students and health professionals.