Wolfsen H C, Carpenter H A, Talley N J
Division of Gastroenterology and Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Gastroenterology. 1993 May;104(5):1310-9. doi: 10.1016/0016-5085(93)90339-e.
Menetrier's disease is characterized by giant gastric folds and foveolar hyperplasia. The extent of mucosal inflammation and glandular atrophy, however, is controversial. The aim of this study was to test the hypothesis that patients previously diagnosed with Menetrier's disease actually represent at least two diseases: (1) Hypertrophic lymphocytic gastritis (HLG) and (2) Massive foveolar hyperplasia and minimal inflammation (MFH).
All cases of possible Menetrier's disease were identified, and their clinical, laboratory, and pathological data were reviewed. In twenty-three patients with giant fundal folds, full-thickness tissue specimens (n = 19) or large suction biopsy (n = 4) tissue specimens were obtained.
Two distinct, nonoverlapping histological patterns were found; 13 patients had HLG and 10 patients had MFH. Clinical features and frequency of Helicobacter pylori were similar in these two groups. Patients with HLG had severe inflammation with numerous intraepithelial lymphocytes and mild foveolar hyperplasia. Alternatively, patients with MFH had greater foveolar hyperplasia, significantly thicker mucosa, and greater mucosal edema.
Patients with MFH represent a form of hypertrophic gastropathy and should be designated as having Menetrier's disease, whereas patients with HLG should be considered part of the spectrum of lymphocytic gastritis.
梅内特里耶病的特征为巨大胃皱襞和小凹增生。然而，黏膜炎症和腺体萎缩的程度存在争议。本研究的目的是检验以下假设：先前诊断为梅内特里耶病的患者实际上至少代表两种疾病：（1）肥厚性淋巴细胞性胃炎（HLG）和（2）巨大小凹增生伴轻度炎症（MFH）。
识别所有可能的梅内特里耶病病例，并回顾其临床、实验室和病理数据。在23例有巨大胃底皱襞的患者中，获取了全层组织标本（n = 19）或大口径吸引活检组织标本（n = 4）。
发现了两种不同的、不重叠的组织学模式；13例患者患有HLG，10例患者患有MFH。这两组患者的临床特征和幽门螺杆菌感染率相似。HLG患者有严重炎症，伴有大量上皮内淋巴细胞和轻度小凹增生。相反，MFH患者有更明显的小凹增生、黏膜显著增厚和更严重的黏膜水肿。
MFH患者代表一种肥厚性胃病形式，应诊断为梅内特里耶病，而HLG患者应被视为淋巴细胞性胃炎谱系的一部分。
