US Quiz December 2020

01/12/2020   0 Comments

Case Report A 39-year-old woman presented with a two months history of epigastric pain partially relieved with proton pump inhibitors (PPI). She had no history of nausea, vomiting, diarrhoea or weight loss. She had no significant medical or family history. Physical examination was unremarkable. The workup revealed haemoglobin of 13.8 g/dL, albumin of 3.6 g/dL and fasting serum gastrin of 37.7 ng/mL. Serologic test for Helicobacter pylori (H. pylori) was positive. An upper gastrointestinal endoscopy revealed giant folds with a polypoid appearance in the greater curvature of the stomach body with sparing of the antrum (Fig. 1). Tissue specimens of altered gastric mucosa were obtained using standard biopsy forceps. Endoscopic ultrasound showed thickening of the mucosal layer of the stomach body with preservation of wall stratification. Antrum wall had normal thickness and structure (Fig. 2 and Video 1). Video 1. EUS showing an echogenic thickening of the mucosal layer wall of stomach body with sparing of the antrum. Quiz Discussion Histology revealed foveolar hyperplasia, glandular tortuosity and dilatation, mucosal oedema and decreased number of parietal cells (Fig. 3). These features are consistent with the diagnosis of Ménétrier’s Disease (MD). The patient was treated with concomitant therapy (PPI, amoxicillin, clarithromycin and metronidazole) for H. pylori eradication. She remains asymptomatic two months after the treatment and H. pylori eradication was verified with urea breath test. Additional invasive procedures were deferred because she became pregnant. MD is a rare, idiopathic hypertrophic gastropathy characterized by giant rugal folds in the gastric body, foveolar hyperplasia and markedly decreased or absent oxyntic glands with antral sparing [1]. The pathogenesis is related to […]

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