A 56yr old man presents with peripheral oedema, and his bloods show a hypoalbuminaemia. A CT abdomen identified thickened rugal folds in the stomach, and subsequent gastric pH testing on endoscopy noted hypochlorhydria. What is the likely diagnosis?
Menetrier disease | |
Mirrizi Syndrome | |
Bouveret syndrome | |
Gastric Lymphoma | |
Zollinger-Ellison Syndrome |
This is a case of Menetrier disease. This is a rare form of hypertrophic gastropathy, characterised by thickened gastric folds on imaging. It results in hyperproduciton of mucous with a resulting protein loosing enteropathy, as well as and hypo/achlorhydria (low or absent stomach acid production). The patient often has oedema, ascites and pleural effusions.
Gastric lymphoma can also present with thickened rugal folds, but would not classically result in a protein losing enteropathy or hypochlorhydria. Zollinger-Ellison syndrome is where a gastrinoma outside the stomach produces gastrin which increases stomach acid production (not reduces it). This condition can be associated with thickened gastric folds.
Bouveret syndrome is where a gallstone erodes through the gallladder and into the duodenum, where it lodges and causes obstruction. It most commonly occurs in elderly women. Mirrizi syndrome is where a large gallstone within the gallbladder causes extrinsic compression of the common bile duct.