Korean J Gastroenterol.  2011 Mar;57(3):184-188. 10.4166/kjg.2011.57.3.184.

A Case of Menetrier's Disease Showing Mucus Bridge Observed during Endoscopy

• Hwang JM
• Kim GH
• Kim WJ
• Lee HS
• Lee HW
• Ryu DY
• Song GA
• Park DY

• KMID: 1128358
• DOI: http://doi.org/10.4166/kjg.2011.57.3.184

Abstract

Menetrier's disease is a rare entity characterized by large, tortuous gastric mucosal folds. The mucosal folds in Menetrier's disease are often most prominent in the body and fundus. Histologically, massive foveolar hyperplasia (hyperplasia of surface and glandular mucous cells) is noted, which replaces most of the chief and parietal cells. Profuse mucus is usually observed during the endoscopy but there have been few cases that show interesting endoscopic findings such as mucus bridge or water pearl. Herein, we report a case of Menetrier's disease showing mucus bridge by excessive mucus observed during the endoscopy.

Keyword

Menetrier's disease; Mucus; Endoscopy

MeSH Terms

2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use
Amoxicillin/therapeutic use
Anti-Bacterial Agents/therapeutic use
Clarithromycin/therapeutic use
Drug Therapy, Combination
Gastric Mucosa/*pathology/secretion
Gastritis, Hypertrophic/*diagnosis/pathology
Gastroscopy
Helicobacter Infections/diagnosis/drug therapy
Helicobacter pylori
Humans
Male
Middle Aged
Mucus/secretion
Proton Pump Inhibitors/therapeutic use
Tomography, X-Ray Computed

Figure

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  Fig. 1. Endoscopic findings. (A) Tortuous enlarged gastric folds were noted. (B) The surface of gastric mucosa was glossy due to overlying mucus. (C) Mucus bridge between gastric folds was observed. (D) Water was not dispersed due to thick mucus, which looked like a pearl.

• 

  Fig. 2. (A) Endosonographic finding. The gastric folds were enlarged due to thickening of only the second layer. Some cystic areas were seen in the thickened second layer (arrows). (B) Abdominal CT finding. It showed markedly enlarged gastric folds.

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  Fig. 3. Gross and microscopic findings. (A) Strip biopsy was performed for definite diagnosis. (B) The resected specimen showed nodular thickening of gastric mucosa. (C) At low power, foveolar hyperplasia was a marked feature. The foveola was elongated and had a corkscrew appearance (H&E, ×40). (D) The lamina propria was moderately infiltrated by inflammatory cells and a mild degree of intraepithelial lymphocytosis was present (H&E, ×100).

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  Fig. 4. Follow-up endoscopic and microscopic findings. (A, B, C) After 6 months of treatment with H. pylori eradication and proton pump inhibitor, the thickening of mucosal folds and the degree of foveolar hyperplasia was decreased (H&E, ×100). (D, E, F) After 18 months of treatment, the thickening of mucosal folds and the degree of foveolar hyperplasia was more decreased (H&E, ×100).

Reference

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