Giant gastric folds in a patient with hypoalbuminaemia

Abstract

A 70-year-old man presented with a 3-month history of persistent epigastric pain, 8 kg weight loss and lower limb swelling. Examination revealed a normal abdomen and bilateral lower limb oedema. Blood results were unremarkable except for hypoalbuminaemia (23 g/l) and peripheral eosinophilia (1.06×109/l). Urinalysis and CT of the abdomen were negative. An oesophagogastroduodenoscopy (OGD) revealed large gastric folds involving the fundus and the body of the stomach (figure 1), and a small antral polyp. Histology showed marked reactive mucosal changes, pronounced foveolar hyperplasia and cystic dilatation (figure 2), compatible with a diagnosis of Ménétrier’s disease. Helicobacter pylori was absent and the antral polyp was adenomatous. He was given omeprazole and prednisolone (20 mg daily), which was tailed down after 2 months. Subsequently, his symptoms improved significantly. He regained 10 kg in weight and his albumin levels normalised. OGD done post therapy and 1 year later still showed prominent, but less pronounced, gastric folds, and histological evidence of hyperplastic gastropathy.