0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Special Feature |

Radiological Case of the Month FREE

[+] Author Affiliations

Section Editor: Beverly P. Wood, MD

More Author Information
Arch Pediatr Adolesc Med. 2001;155(11):1273-1274. doi:10.1001/archpedi.155.11.1273.
Text Size: A A A
Published online

DENOUEMENT AND DISCUSSION: HYPERTROPHIC GASTROPATHY WITH EDEMA

Figure 1. Abdominal ultasound shows marked thickening of gastric rugae.

A diagnosis of hypertrophic gastropathy with cytomegalovirus infection was made. Hypertrophic gastropathy of childhood has been reported in children with a mean age of 5 years. The initial symptoms include vomiting, diarrhea, abdominal pain, and anorexia. On physical examination, peripheral edema is usually present. Laboratory results show low serum albumin and protein-losing enteropathy proven by analysis of chromium-labeled albumin or stool α1-antitrypsin.

There are 2 diagnostic criteria for hypertrophic gastropathy: (1) giant gastric rugae by imaging, endoscopy, or laparotomy; and (2) characteristic histologic findings of foveolar hyperplasia and cystic dilation of submucosal glands.

The appearance of hypertrophic gastropathy has been analyzed by endoscopic ultrasound and endoscopy in previous studies. In the study by Hizawa et al,1 every patient had giant gastric folds 13 to 20 mm in diameter resulting from thickening of the mucosal layer with or without cystic components. By ultrasound study, the thickened mucosa was echogenic and Helicobacter pylori was the causative agent in most adult patients. Approximately 55 cases of hypertropic gastropathy in children have been published. In contrast to the chronic course of Ménétrier disease in adults, the pediatric cases are generally benign, self-limited, and show complete resolution within a few weeks.2 The benign pediatric hypertrophic gastropathies have been associated with infections, primarily cytomegalovirus3 and occasionally H pylori, herpes simplex, and mycoplasma.2,4

Abdominal scintigraphy using technetium Tc 99m-labeled human serum albumin delivered intravenously and direct measurement of protein in gastric juice has proven that serum proteins are massively secreted in the stomach.5 Supportive treatment with a high-protein diet and intravenous albumin transfusions is recommended. H2-receptor antagonist use may improve symptoms.2,6

Reprints: Moshe Nussinovitch, MD, Department of Paediatrics C, Schneider Children's Medical Centre of Israel, Petach Tikvah, Israel.

Hizawa  KKawasaki  MYao  T  et al.  Endoscopic ultrasound features of protein-losing gastropathy with hypertrophic gastric folds. Endoscopy. 2000;32394- 397
Link to Article
Kindermann  AKoletzko  S Protein-losing giant fold gastritis in childhood—a case report and differentiation from Menetrier disease of adulthood. Z Gastroenterol. 1998;36165- 171
Eisenstat  DDGriffiths  AMCutz  EPetric  MDrumm  B Acute cytomegalovirus infection in a child with Menetrier's disease. Gastroenterology. 1995;109592- 595
Link to Article
Ben Amitai  DZahavi  IDinari  GGarty  BZ Transient protein-losing hypertrophic gastropathy associated with Mycoplasma pneumoniae infection in childhood. J Pediatr Gastroenterol Nutr. 1992;14237- 239
Link to Article
Yamada  MSumazaki  RAdachi  H  et al.  Resolution of protein-losing hypertrophic gastropathy by eradication of Helicobacter pyloriEur J Pediatr. 1997;156182- 185
Link to Article
Kaneko  TAkamatsu  TGotoh  A  et al.  Remission of Ménétriér's disease after a prolonged period with therapeutic eradication of Helicobacter pyloriAm J Gastroenterol. 1999;94272- 273

Tables

References

Hizawa  KKawasaki  MYao  T  et al.  Endoscopic ultrasound features of protein-losing gastropathy with hypertrophic gastric folds. Endoscopy. 2000;32394- 397
Link to Article
Kindermann  AKoletzko  S Protein-losing giant fold gastritis in childhood—a case report and differentiation from Menetrier disease of adulthood. Z Gastroenterol. 1998;36165- 171
Eisenstat  DDGriffiths  AMCutz  EPetric  MDrumm  B Acute cytomegalovirus infection in a child with Menetrier's disease. Gastroenterology. 1995;109592- 595
Link to Article
Ben Amitai  DZahavi  IDinari  GGarty  BZ Transient protein-losing hypertrophic gastropathy associated with Mycoplasma pneumoniae infection in childhood. J Pediatr Gastroenterol Nutr. 1992;14237- 239
Link to Article
Yamada  MSumazaki  RAdachi  H  et al.  Resolution of protein-losing hypertrophic gastropathy by eradication of Helicobacter pyloriEur J Pediatr. 1997;156182- 185
Link to Article
Kaneko  TAkamatsu  TGotoh  A  et al.  Remission of Ménétriér's disease after a prolonged period with therapeutic eradication of Helicobacter pyloriAm J Gastroenterol. 1999;94272- 273

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
JAMAevidence.com

The Rational Clinical Examination
3. Loss of Fluid From the Intravascular to Extravascular Space, Namely, Ankle or Sacral Edema and Ascites

The Rational Clinical Examination EDUCATION GUIDES
Ascites