Uncommon Gastritis Syndromes

This rare idiopathic disorder affects adults aged 30 to 60 and is more common among men. It manifests as a significant thickening of the gastric folds of the gastric body but not the antrum. Gland atrophy and marked foveolar pit hyperplasia occur, often accompanied by mucous gland metaplasia and increased mucosal thickness with little inflammation. Hypoalbuminemia (the most consistent laboratory abnormality) caused by gastrointestinal protein loss may be present (protein-losing gastropathy). As the disease progresses, the secretion of acid and pepsin decreases, causing hypochlorhydria.

Symptoms of Ménétrier disease are nonspecific and commonly include epigastric pain, nausea, weight loss, edema, and diarrhea.

Diagnosis of Ménétrier disease is made by endoscopy with deep mucosal biopsy or full-thickness laparoscopic gastric biopsy.

Differential diagnosis includes the following:

Various treatments have been used, including anticholinergics, antisecretory medications, and corticosteroids, but none have proved fully effective. Partial or complete gastric resection may be necessary in cases of severe hypoalbuminemia.

Extensive infiltration of the mucosa, submucosa, and muscle layers with eosinophils often occurs in the antrum. It is usually idiopathic but may result from nematode infestation.

Symptoms of eosinophilic gastritis include nausea, vomiting, and early satiety.

Diagnosis of eosinophilic gastritis is by endoscopic biopsy of involved areas.

Corticosteroids can be successful in idiopathic cases; however, if pyloric obstruction develops, surgery may be required.

This rare condition is characterized by massive lymphoid infiltration of the gastric mucosa, which can grossly resemble Ménétrier disease Ménétrier Disease Gastritis is inflammation of the gastric mucosa caused by any of several conditions, including Helicobacter pylori infection, drugs (nonsteroidal anti-inflammatory drugs [NSAIDs], alcohol),... read more but is distinguished on histologic examination.

Treatment of Helicobacter pylori infection Treatment A peptic ulcer is an erosion in a segment of the gastrointestinal mucosa, typically in the stomach (gastric ulcer) or the first few centimeters of the duodenum (duodenal ulcer), that penetrates... read more may be curative in MALT lymphoma localized to the stomach.

Sarcoidosis Sarcoidosis Sarcoidosis is an inflammatory disorder resulting in noncaseating granulomas in one or more organs and tissues; etiology is unknown. The lungs and lymphatic system are most often affected, but... read more , tuberculosis Tuberculosis (TB) Tuberculosis is a chronic, progressive mycobacterial infection, often with an asymptomatic latent period following initial infection. Tuberculosis most commonly affects the lungs. Symptoms include... read more , amyloidosis Amyloidosis Amyloidosis is any of a group of disparate conditions characterized by extracellular deposition of insoluble fibrils composed of misaggregated proteins. These proteins may accumulate locally... read more , and other granulomatous diseases can cause gastritis, which is seldom of primary importance.

Radiation and ingestion of corrosives (especially acidic compounds) can cause gastritis. Exposure to > 6 gray of whole-body radiation (see Acute radiation syndromes Acute radiation syndromes (ARS) Ionizing radiation injures tissues variably, depending on factors such as radiation dose, rate of exposure, type of radiation, and part of the body exposed. Symptoms may be local (eg, burns)... read more ) causes marked deep gastritis, usually involving the antrum more than the corpus. Pyloric stenosis and perforation are possible complications of radiation-induced gastritis.

Except for H. pylori infection Helicobacter pylori Infection Helicobacter pylori is a common gastric pathogen that causes gastritis, peptic ulcer disease, gastric adenocarcinoma, and low-grade gastric lymphoma. Infection may be asymptomatic or... read more , bacterial invasion of the stomach is rare and mainly occurs after ischemia, ingestion of corrosives, or exposure to radiation. On x-ray, gas outlines the mucosa. The condition can manifest as an acute surgical abdomen and has a very high mortality rate. Surgery is often necessary.

Debilitated or immunocompromised patients may develop viral or fungal gastritis with cytomegalovirus Cytomegalovirus (CMV) Infection Cytomegalovirus (CMV, human herpesvirus type 5) can cause infections that have a wide range of severity. A syndrome of infectious mononucleosis that lacks severe pharyngitis is common. Severe... read more , candidiasis Candidiasis Candidiasis is infection by Candida species (most often C. albicans), manifested by mucocutaneous lesions, fungemia, and sometimes focal infection of multiple sites. Symptoms depend... read more , histoplasmosis Histoplasmosis Histoplasmosis is a pulmonary and hematogenous disease caused by Histoplasma capsulatum; it is often chronic and usually follows an asymptomatic primary infection. Symptoms are those... read more , or mucormycosis Mucormycosis Mucormycosis refers to infection caused by diverse fungal organisms in the order Mucorales, including those in the genera Rhizopus, Rhizomucor, and Mucor. Symptoms of rhinocerebral... read more ; these diagnoses should be considered in patients with exudative gastritis, esophagitis, or duodenitis.