gastrins and Protein-Losing-Enteropathies

A 47-yr-old man with Ménétrier's disease presented with profound enteral protein losses documented by 51Cr-albumin stool studies. There was no response to anticholinergics, H2-receptor antagonists, or proton pump inhibition. Subcutaneous octreotide acetate, 100 micrograms bid, resulted in clinical improvement with rapid resolution of enteral protein losses. Octreotide was continued for 12 months. During an additional 5-month follow-up period without therapy, the patient remained improved clinically with low to normal serum proteins, despite the persistence of gastric rugal hypertrophy. The evidence that octreotide resolved enteral protein losses and eliminated the need for urgent gastrectomy in our patient warrants a trial of this drug for other patients with Ménétrier's disease.

Topics: Albumins; Chromium Radioisotopes; Epidermal Growth Factor; Feces; Gastric Acid; Gastrins; Gastritis, Hypertrophic; Humans; Injections, Subcutaneous; Male; Middle Aged; Octreotide; Protein-Losing Enteropathies; Saliva

Hypertrophic protein-losing gastropathy is a rare clinical entity of unknown etiology. Seventeen of 50 GI Units in The Netherlands, surveying their patient material, documented at least 1 positive case. Altogether, 40 patients (25 male and 15 female; mean age, 44.3 years) fulfilled the usually accepted criteria. Main complaints were epigastric pain (65%), asthenia (60%), anorexia (45%), weight loss 45%, edema (37.5%), and vomiting (37.5%). Hypoalbuminemia of < 35 g/l was found in 81%, and an abnormal enteric protein loss (51CrCl3) in 22 of 26 tested patients (85%). The mean basal acid output was 0.99 mmolH+/h. Stomach radiology in 35 patients showed giant folds mainly of the corpus mucosa; endoscopy confirmed the hypertrophy of the folds in all cases (in four confirmed by endosonography) and the presence of adherent mucus. Occasionally a concomitant gastric ulcer was found. Endoscopic biopsies were usually of limited value for the histologic diagnosis, mainly suggesting the possibility of hypertrophic gastropathy, excluding gastric cancer or lymphoma. In the follow-up 80% was treated with antacids, H2-receptor antagonists, mucosa-protectives, omeprazole, or combinations. No single agent appeared of major value. Eradication of Helicobacter pylori occasionally reduced symptoms. Twenty-two patients (55%) improved with or without medical therapy, during a mean follow-up of 7.6 years. Five patients (12.5%) underwent gastric surgery; four improved. In total, 26 patients (65%) improved, with partial or total regression of hypoalbuminemia. Eight patients died, three of gastric cancer, and five of cancers localized elsewhere.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Female; Gastric Acid; Gastrins; Gastritis, Hypertrophic; Humans; Male; Middle Aged; Protein-Losing Enteropathies; Retrospective Studies; Serum Albumin

A case with proteinlosing gastropathy with gastric hypersecretion of H+ and pepsin as well as hypergastrinemia is presented. Zollinger-Ellison syndrome was excluded by reduction in acid secretion and serum gastrin during the observation period as well as by the effect on gastric secretion and serum gastrin after injections of secretin and glucagon.

Topics: Adult; Diagnosis, Differential; Female; Gastric Juice; Gastrins; Humans; Pepsin A; Protein-Losing Enteropathies; Radiography; Stomach; Zollinger-Ellison Syndrome

Serial morphological, secretory, and serological observations of a patient with Ménétrier's disease disclosed hypergastrinemia, antibodies to parietal cells and dietary substances, and an acute reduction of gastrointestinal protein loss after atropine administration. Transformation of the gastric mucosa from hypertrophy to atrophic gastritis was associated with disappearance of the protein-losing gastroenteropathy and serum antibodies and reduction of the serum gastrin concentration.

Topics: Antibodies; Gastric Juice; Gastric Mucosa; Gastrins; Gastritis; Humans; Hypertrophy; Male; Middle Aged; Protein-Losing Enteropathies

Topics: Achlorhydria; Chronic Disease; Gastric Juice; Gastric Mucosa; Gastrins; Gastritis; Histamine; Humans; Hydrogen-Ion Concentration; Hypertrophy; Insulin; Intubation, Gastrointestinal; Protein-Losing Enteropathies; Stimulation, Chemical; Stomach; Stomach Diseases; Stomach Ulcer; Zollinger-Ellison Syndrome