Endoscopic Ultrasound Features of Protein-Losing Gastropathy with Hypertrophic Gastric Folds

Background and Study Aims: We aim to clarify the endoscopic ultrasound (EUS) features of protein-losing gastropathy with hypertrophic gastric folds (PLGH), including Ménétrier's disease.

Patients and Methods: We analyzed the EUS and histologic findings in five patients who underwent both endoscopic ultrasonography and endoscopic resection.

Results: Histologically, we diagnosed one patient as having acute gastritis, three patients as having Ménétrier's disease, and the remaining patient as having hypertrophic lymphocytic gastritis (HLG). Helicobacter pylori was recognized in all but one patient. At EUS every patient was found to have giant gastric folds (13 to 20 mm in diameter), resulting from echogenic thickening of the mucosal layer with or without cystic components. Two patients who underwent eradication therapy of H. pylori showed both clinical and morphologic resolution.

Conclusions: Echogenic thickening of the mucosal layer may be a characteristic EUS feature of protein-losing gastropathy with hypertrophic gastric folds, and H. pylori may be one of the causative agents.

Reference

• 1 Wolfsen H C, Carpenter H A, Talley N J. Ménétrier's disease: a form of hypertrophic gastropathy or gastritis?.  Gastroenterology. 1993;  104 1310-1319
• 2 Bayerdörffer E, Ritter M M, Hatz R, et al. Healing of protein losing hypertrophic gastropathy by eradication of Helicobacter pylori: is Helicobacter pylori a pathogenic factor in Ménétrier's disease?.  Gut. 1994;  35 701-704
• 3 Groisman G M, George J, Berman D, et al. Resolution of protein-losing hypertrophic lymphocytic gastritis with therapeutic eradication of Helicobacter pylori.  Am J Gastroenterol. 1994;  89 1548-1551
• 4 Kawasaki M, Hizawa K, Aoyagi K, et al. Ménétrier's disease associated with Helicobacter pylori infection.  Am J Gastroenterol. 1997;  92 1909-1912
• 5 Palazzo L, Roseau G, Napoleon B, et al. Ménétrier's disease: endosonographic findings in 23 cases (abstract).  Gastrointest Endosc. 1993;  39 150
• 6 Songür Y, Okai T, Watanabe H, et al. Endosonographic evaluation of giant gastric folds.  Gastrointest Endosc. 1995;  41 468-474
• 7 Maunoury V, Klein O, Houche M L, et al. Endoscopic ultrasonography in the diagnosis of hypertrophic gastropathy.  Gastroenterology. 1994;  106 820
• 8 Avunduk C, Navab F, Hampf F, et al. Prevalence of Helicobacter pylori infection in patients with large gastric folds.  Am J Gastroenterol. 1995;  90 1969-1973