Giant hypertrophic gastritis (GHG) is a general term for inflammation of the stomach due to the accumulation of inflammatory cells in the inner wall (mucosa) of the stomach resulting in abnormally large, coiled ridges or folds that resemble polyps in the inner wall of the stomach (hypertrophic gastric folds). GHG encompasses a collection of disorders. The symptoms of GHG may vary from case to case. The exact cause of GHG is unknown.
There is considerable confusion and contradiction in the medical literature regarding disorders involving large gastric folds. GHG is often used as a synonym for Menetrier disease. However, Menetrier disease is not a true form of gastritis. A diagnosis of Menetrier disease should indicate massive overgrowth of mucous cells (foveola) in the gastric mucosa (foveolar hyperplasia) and minimal inflammation. Foveolar hyperplasia results in large gastric folds. Because inflammation is minimal, Menetrier disease is classified as a form of hyperplastic gastropathy and not a form of gastritis. Some researchers believe that GHG and Menetrier disease may be variants of the same disorder or different parts of one disease spectrum.
The symptoms of giant hypertrophic gastritis may vary from case to case. Some individuals may not exhibit any symptoms (asymptomatic). Common symptoms that do occur include nausea, vomiting, diarrhea and pain in the upper middle region of the stomach (epigastric pain). In some cases, weight loss and profound loss of appetite (anorexia) may also occur.
Variable findings sometimes associated with GHG include low levels of the protein albumin (hypoalbuminemia), which may result in fluid accumulation (edema) in the stomach. Gastrointestinal bleeding has also been reported in some cases.
The exact cause of giant hypertrophic gastritis is unknown. Some researchers speculate that an exaggerated immune system response to an as yet unknown foreign or invading substance (antigen) may cause the disorder.
Individuals with GHG may also have another form of gastritis such as acute Helicobacter pylori gastritis. A form of GHG called lymphocytic gastritis occurs with greater frequency in children with a digestive disorder known as celiac sprue. However, the exact relationship, if any, among these disorders is not understood.
Some researchers have speculated that Helicobacter pylori infection plays a causative role in the development of GHG. However, no evidence has conclusively linked H. pylori infection to the development of GHG.
Giant hypertrophic gastritis affects males and females in equal numbers. It can affect children or adults but occurs with greater frequency in late adulthood.
A diagnosis of giant hypertrophic gastritis may be suspected in individuals with large gastric folds. Large gastric folds may be diagnosed by an endoscopy, a procedure in which a thin, flexible tube (endoscope) is inserted through the mouth and used to examine the interior of the stomach and obtain tissue samples for microscopic study (biopsy).
A diagnosis of GHG may be confirmed based upon a thorough clinical evaluation, a detailed patient history, and the histiopathologic examination of affected stomach tissue, which shows characteristic accumulation of inflammatory cells in the gastric mucosa.
There is no specific treatment for individuals with GHG. Treatment is symptomatic and supportive. In cases where H. pylori infection is documented affected individuals should receive antibacterial therapy.
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Recent studies suggest that the drug octreotide may be useful in reducing protein loss from the stomach associated with Giant Hypertrophic Gastritis. More study is needed to determine the long-term safety and effectiveness of this drug for the treatment of this disorder.
Some clinical researchers believe that Giant Hypertrophic Gastritis is the result of a stomach infection by the bacterium Helicobacter pylori, the agent that causes peptic ulcers. They are studying the effect of eliminating all traces of the bacterium from the stomachs of patients with the disorder.
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