Giant hypertrophic gastritis

Introduction to huge hypertrophic gastritis Huge hypertrophic gastritis is caused by excessive hyperplasia of the gastric mucosa, which makes the stomach wall wide-thick. In 1888, Ménétrier first proposed it, hence the name Ménétrier disease. basic knowledge The proportion of illness: 0.006%-0.008% Susceptible people: good for people over 50 years old Mode of infection: non-infectious Complications: edema

Cause of huge hypertrophic gastritis

(1) Causes of the disease

The etiology of this disease remains unclear. Studies have shown that children may be associated with cytomegalovirus infection. Trasforming growth factator alpha may play a role in the pathogenesis of adults and children. Its role may be similar in AIDS patients. Ménétrier's disease-like hypertrophic wrinkles may be associated with cytomegalovirus infection. Larsen reviewed the literature and followed up with three families and concluded that the disease had little to do with genetics.

(two) pathogenesis

In the literature, giants, massive, hypertrophy, hyperplasia, polypoids, and bulbouss are often used to describe the appearance of gastric mucosa. The lesions can be localized or extensive, and are often involved. The site is the acid secretion zone of the stomach, that is, the acid-mud mucosa of the stomach and stomach, but it can also involve the gastric antrum, even the proximal end of the duodenum. The stomach is soft and smooth, and there are large, swollen and non-elastic wrinkles, separated by deep grooves. Hypertrophic wrinkles can reach 1.5cm wide, 3~4cm high, the weight of the stomach can be increased to 1200g, the most resected stomach is often heavier than 500g, the huge wrinkles are mostly in the big bend, and some have extensive limitations, which can be connected with the normal mucosa. It is sudden or gradual. The surface of the mucous membrane is exuded or eroded, showing a nodular or polypoid appearance, often not covered by a large amount of mucus.

Microscopically, it is mainly the hyperplasia of the epithelial epithelium, which makes the glandular fossa significantly prolonged and flexed. With the obvious hyperplasia of the folds, the mucosa will fold up and the mucosal muscles and blood vessels will be brought in at the same time. The basement mucosa between the two folds can be Normal or thinning, the fundus glands are long and straight, the parietal cells look normal and distributed in some areas, but glandular cystic dilatation can be seen in other parts, and most mucus-secreting cells are present, and mucus cells account for the entire mucosa. 1/3, in severe cases, the glandular ducts all become glandular fossa, and the sac can penetrate the mucosal muscles to the submucosa. According to Maimon, the mucosa changes much like the crypt of chronic cystitis.

It can be seen that neutrophil tube type, lamina propria and mucosal myometrial lymphocytic infiltration, eosinophils are very prominent, gastric atrophy of intestinal metaplasia is not common in this disease, mucosal muscle hypertrophy, the muscularis propria can also be fibrotic And edema, submucosal edema, increased blood vessels.

Kelly observed the ultrastructure of gastric mucosa in seven patients by electron microscopy and found that the tight junction of gastric epithelial cells was significantly broadened and considered to be one of the main causes of protein leakage.

Huge hypertrophic gastritis prevention

There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

1, pay attention to diet: regular timing of meals, chewing slowly, to light, irritating food for the gastric mucosa, to avoid spicy, cold, hard, too acidic and other irritating food.

2, quit smoking and alcohol: alcohol and tobacco will have damage to the gastric mucosa, causing mucous membrane erosion, congestion, thereby aggravating the condition, is not conducive to the rehabilitation of the disease.

3, use drugs with caution: Some drugs, such as non-steroidal anti-inflammatory drugs, can stimulate the gastric mucosa, causing repeated attacks. Should be used with caution or avoided as much as possible.

4, active treatment: suffering from diseases, should be actively treated, whether it is acute gastritis or other diseases, in order to avoid further expansion of the disease, involving other mucosal tissues, causing more serious diseases.

Huge hypertrophic gastritis complications Complications edema

Hypoproteinemia and edema caused by leakage of plasma albumin into the stomach cavity through the proliferated gastric mucosa.

Huge hypertrophic gastritis symptoms common symptoms abdominal pain nausea hypoproteinemia fatty diarrhea cachexia gastric loss protein chronic stomach pain

Pain in the upper abdomen, such as ulcers, can be relieved after meals, loss of appetite, common nausea, such as polypoid wrinkles, occlusion can cause vomiting, sometimes bleeding, surgery, loss of weight due to protein loss and steatorrhea, weakness, edema Even worse, it is a cachectic disease, and the stomach loses protein. Citrix first found that there is albumin in the gastric juice of the patient, which confirmed the loss of protein in the gastric mucosa. The exchangeable albumin pool in the body is equivalent to 1/3 of healthy people. The 131I-labeled albumin measures 3 times the albumin renewal rate per day, and about 6g of albumin is decomposed in the stomach. It can be digested and reabsorbed from the albumin lost in the stomach to the new albumin synthesis. However, it is difficult to compensate. Citrin reviewed 23 cases, 16 of which had hypoproteinemia (6.0%). Maimon found that the plasma protein decreased from 5.1g to 3.8g within 2 weeks, and protein loss was naturally relieved. However, some patients need to perform most or total gastrectomy. The cause of protein loss is unknown, and the gastric mucosal barrier may be damaged.

Inspection of huge hypertrophic gastritis

Gastric acid secretion: Due to epithelial hyperplasia, there is a large amount of mucus in gastric juice, 50% of patients have no acid. A few patients can have high acidity and ulceration. Histology shows typical glandular follicles, and main cells and parietal cells also increase.

1. X-ray examination: huge buckling of the folds, polypoid changes on the large curved side, wrinkles are not as clear and soft as normal, creep waves are reduced, and movement is slow, 60% of 127 cases are suspected of having malignant lesions.

2. Gastroscopy: visible huge wrinkles, does not disappear after inflation, pale as a stick, mucus is particularly large, wrinkled surface is irregular, often in the same size or nodular, there are deep cracks between the folds, the surface color can be pale Gray or red, in general, the diagnosis of gastroscope is not easy: 1 is not easy to consider the disease; 2 is not easy to identify, Filer reported that only 8 cases in 26 cases made a correct diagnosis.

3. Ultrasound gastroscopy: the mucosal layer of the lesion is significantly thickened.

Diagnosis and differentiation of huge hypertrophic gastritis

diagnosis

Patients with upper abdominal pain and hypoproteinemia should be suspected of the disease, X-ray and gastroscopy, if the above examination confirmed that there is a large fold, biopsy should be done, if necessary, thermal biopsy, large biopsy (endoscopic mucosal resection) And surgical exploration.

Differential diagnosis

The disease should be differentiated from gastric malignant lymphoma, invasive gastric cancer, Zollinger-Ellson syndrome, gastric tuberculosis, gastric amyloidosis, and the gastric mucosal histology of Cronkhite-Canada syndrome is similar to this disease. However, the clinical identification is easier. The former has alopecia, atrophy of the nail, skin pigmentation and multiple polyps in the digestive tract.

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