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Gastric Neoplasms and Gastroenteropancreatic Neuroendocrine Tumors. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 77-96.

This chapter on gastric neoplasms and gastroenteropancreatic neuroendocrine tumors is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. Of the various neoplasms that can affect the stomach, adenocarcinoma is the most common and accounts for up to 95 percent of all gastric neoplasms. Less common are gastric lymphomas, gastrointestinal stromal tumors, neuroendocrine tumors, and metastatic disease involving the stomach. The chapter covers epidemiology, pathogenesis, clinical presentation, risk factors, diagnostic evaluation, treatment, and prognosis of these neoplastic diseases. Risk factors discussed include diet, tobacco use, gastric surgery, infection, genetics, and gastric disorders such as pernicious anemia and Menetrier’s disease. The clinical features of gastric cancer are vague, but weight loss, nausea, and anorexia are common with advanced lesions. Surgery is the mainstay of treatment for gastric cancer. The prognosis for gastric adenocarcinoma remains grim for all but those who are candidates for surgical resection. Prognosis after surgical resection varies according to the pathologic extent of disease, staging and the population studied. The chapter is illustrated with full-color drawings and photographs and includes two patient care algorithms. 7 figures. 3 tables. 11 references.

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Gastritis. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 67-76.

This chapter on gastritis is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. Gastritis is a term for inflammation in the gastric mucosa due to mucosal injury. The chapter covers histopathology, acute gastritis, chronic gastritis, atrophic gastritis, chronic reactive gastritis, infectious gastritis, lymphocytic gastritis, granulomatous gastritis, eosinophilic gastritis, gastric antral vascular ectasia, portal hypertensive gastropathy, and Menetrier’s disease. Gastritis can have various appearances on endoscopic examination, including erosions, erythema, nodularity, or thickened gastric folds. Diagnosis is based on histologic findings and the patient’s clinical history. Treatment is usually targeted at withdrawing the offending agent or treating an underlying infection or systemic disease. Gastropathy is a term used to describe epithelial damage without associated inflammation. The most common types are vascular and hypertrophic. The chapter is illustrated with full-color drawings and photographs. 4 figures. 1 table. 9 references.

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Menetrier Disease. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2008. 4 p.

This fact sheet describes Menetrier disease, a condition that causes the ridges along the inside of the stomach wall to enlarge, forming giant folds in the lining of the stomach. These ridges, or rugae, enlarge because of an overgrowth of surface mucous cells of the stomach. Enlarged rugae release too much mucus, causing a leakage of protein from the blood into the stomach. This shortage of protein in the blood is known as hypoproteinemia. Menetrier disease also causes a decrease in stomach acid resulting from a reduction in acid-producing parietal cells. The fact sheet answers common questions about Menetrier disease, including the causes of the condition, the symptoms, diagnostic approaches, and treatment options. Menetrier disease is rare and more common in men than in women, usually appearing between the ages of 30 and 60. Recent studies suggest that people with Menetrier disease have stomachs that make abnormally high amounts of transforming growth factor alpha, a protein that tells cells what to do. Menetrier disease is diagnosed through x rays, endoscopy, and biopsy of stomach tissue. Treatment options include medications to relieve nausea and pain, and surgery to remove part or all of the stomach. Readers are referred to the National Organization for Rare Disorders (www.rarediseases.org or 1–800–999–6673) for more information. The fact sheet concludes with a brief description of the National Digestive Diseases Information Clearinghouse, which provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public.

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Menetrier Disease and Gastrointestinal Stromal Tumors: Hyperproliferative Disorders of the Stomach. Journal of Clinical Investigation. 117(1): 70-80. January 2007.

This article describes two hyperproliferative disorders of the stomach: Menetrier disease and gastrointestinal stromal tumors (GISTs). Both conditions are caused by dysregulated receptor tyrosine kinases (RTKs). The authors review the clinical features, pathogenesis, role of progenitor cells, molecular therapy, and future directions for research on these disorders. The authors stress that these conditions arise from dysregulation of different progenitor cell populations and the importance of cellular context in the pathogenesis of proliferative disorders. Clinically beneficial targeted molecular therapeutics exist for these diseases. People with Menetrier disease can be effectively treated with a blocking monoclonal antibody specific for Epidermal growth factor receptor (EGFR). People with GIST can be treated with tyrosine kinase inhibitors. However, despite the effectiveness of imatinib for treating advanced GISTs, most patients experience tumor progression as the tumor becomes resistant to imatinib. The authors conclude by discussing some issues of classification and whether or not Menetrier disease is one disorder or a spectrum of disorders. 4 figures. 1 table. 108 references.

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Giant Hypertrophic Gastritis and Menetrier’s Disease. Danbury, CT: National Organization for Rare Disorders. 2006. 4 p.

This brochure familiarizes physicians with giant hypertrophic gastritis and Menetrier’s disease, rare digestive disorders that are both characterized by large folds of tissue in the mucosal wall of the stomach. Giant hypertrophic gastritis is a general term for a group of disorders in which the gastric folds are caused by the proliferation of inflammatory cells into the mucosal wall of the stomach. Menetrier’s disease is characterized by large gastric folds that occur because of massive mucous cell hyperplasia; minimal or no inflammation is associated with Menetrier’s. The brochure covers the importance of distinguishing between these conditions, the symptoms associated with each, the etiology, the potential role of Helicobacter pylori (H. pylori) infection in the development of these disorders, diagnostic approaches, and treatment strategies. These conditions may be suspected in individuals in whom an endoscopy reveals large gastric folds. No specific treatment exists for giant hypertrophic gastritis, although in patients with H. pylori infection, a regimen of antibiotics may be indicated. Menetrier’s disease has been treated with anticholinergic drugs, acid suppression therapy, and antibiotic therapy directed against H. pylori infection. In severe cases of Menetrier’s disease, partial or total gastrectomy may be necessary. The brochure concludes with the contact information for the National Digestive Diseases Information Clearinghouse (digestive.niddk.nih.gov or 1–800–891–5389) and the National Organization for Rare Disorders (NORD). The back cover of the brochure describes the work of NORD and the publications available for physician education.

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