Meta-analysis Of Ménétrier's Disease

Objective Menetrier's disease is a rare hyperprolliferative disorder of the stomach with whose precise etiology has remained enigmatic. The typical hallmark of Menetrier's disease is the presence of copious amounts of thick mucus and diffusely enlarged rugae folds looking like convolution of the brain. Pateints usually present with a unique constellation of signs and symptoms that include hypoproteinemia, abdominal pain, fatigue, weight loss and so on. There is no consensus about which of these features define the disease and literautures are mostly case reports. Menetrier's disease is thought to carry a risk of gastric cancer but transformation to adenocarcinoma is uncommon. If empiric treatment with acid suppression, anti-cholinergic therapy, octreotide, prednisone, as well as eradication of H.pylori fails, partial or total gastrectomy is the best solution. To enhance the realization of the disease, a meta-analysis of Menetrier's disease in China reported in the literature.Methods Using " Menetrier's disease " or "hypertrophic gastropathy" as key words, search "CNKI", "Wanfang network database", "Vip network database" for literature published in Chinese from 1989 to 2010. Diagnosis requires clinical, radiologic or endoscopic correlation with the morphologica findings. Then collect all the literatures and conduct meta-analysis.Results Up to now, there are 36 literatures reported in China. For all the 72 cases, there are 54 males and 24 females. The ration of male to female is 3:1. The minimum age of diagnose is 6 year old and the maximum is 72 year old. Mean age is 49.1±13.9 while median age is 53.6 year old.10 patients are found to have etiological causes of the disease, such as alcohol aburse, durg intake, virus infection and so on. Abdominal pain, poor appetite, nausea, vomiting, edema of preripheral tissues, and anemia are common symptoms and 76.4% patients present with hypoproteinemia. Both at radiologic and endoscopic examination, Menetrier's disease typically involves the fundus and body of the stomach but spares the antrum and 1/3 of the patients have gastric peristalsis problem. An upper endoscopy reveals large obilated folds and the mucosa has a finely cobblestone appearance, which can not be fully expanded even with gas injection. There are 51 cases of endoscopic biopsy. The patology report with Menetrier's disease in 21 cases, adenocarcinoma in 3 cases. While diagnosing Menetrier's disease, gastrointestinal contrasct is more validity and reliable, whose sensitivity 89.1%, misdiagnosed rate 10.9%. When suspicious cancer existed, gastroscopy is of greater use with 50% sensitivity and 50% misdiagnosed rate. Once combinng these two methods, sensitivity has a salience lift to 91.3%, while the misdiagnosed rate drop to 8.7%. However, it could possibly miss caucerous lesions. In China,24 patients treated with gastrectomy and 6 of them recover well in the clinical follow-up. Among the 16 patients who accept empiric treatment,7 cases recoers well with 1 patient passed away.Conclusion Menetrier's disease is an uncommon, idiopathic, hypertrophic gastropathy associated with hypoproteinemia. It occurs more in men and the middle-aged. Patients usually complain abdominal pain, poor appetite, nausea, vomiting, edema, weight loss, fatigue and anemia. Gastric involovement is usually localized to the fundus and body, with the greater curvature most prominent. But it can be diffuse and include the antrum and carida, seldomly with the duodenum involved. Thick, contorted and tortuous rugae are the typical mark. Gastrointestinal contrast is more sensitivity on checking up Menetrier's disease. Endoscopy is better at diagnosing Menetrier's disease with cacer. If pharmacologic therapy fails, gastric resection is still the most definitive treatment for the disease.