An unusual association of Ménétrier's disease with a gastric bezoar.

Ménétrier's disease is a rare protein-losing hypertrophic gastroenteropathy. While it still remains a medical curiosity, infection with Cytomegalovirus and Helicobacter pylori, and hormonal, congenital, dietary and neurogenic factors have been postulated as causative factors. We describe a case of a 14-year boy who presented with epigastric discomfort, vomiting, inability to gain weight and pedal oedema. Investigations revealed hypoproteinaemia without proteinuria and elevated faecal α-1-antitrypsin levels suggestive of protein-losing enteropathy. Imaging and endoscopic features demonstrated cerebriform gastric folds indicative of Ménétrier's disease. Infective, hormonal and neurogenic causes were ruled out in our patient. Surprisingly, the patient had a history of pica and an associated large gastric bezoar, which was ultimately removed surgically. An association of Ménétrier's disease with a bezoar has been reported only once previously. We thus add to the existing literature and highlight the plausible role of a bezoar as a causative factor in the pathogenesis of Ménétrier's disease due to its irritant nature.