Menetries disease, in the language of physicians referred to as hypertrophic polyadenomatous gastritis, belongs to the category of rare diseases of the stomach with an unidentified etiology.
Pathology is the name of the French pathologist Pierre Eugene Menetries, first described it in 1888.The medical literature describes no more than three hundred cases of this ailment.
Concept of the disease
Menetria disease provokes hypertrophic development of the mucous membranes of the stomach, in the structures of which gradually develop gradually increasing adenomas and cysts.
The latter secrete a huge amount of viscous mucus, resulting in a leakage of proteins from the blood plasma.
So there is hypoproteinemia - a pathological condition characterized by an abnormally low level of protein in the blood plasma.
Menetries disease has many synonymous names. In medical sources it is called:
- by a tumor-like gastritis;
- exudative gastropathy;
- giant hypertrophic gastritis;
- adenopapillomatosis;
- with a giant gastritis;
- of excess gastric mucosa.
Causes of development of
Genetic causes contributing to the occurrence of Menetria have been studied to an insufficient extent to this day. There is an assumption that the disease can develop under the influence of:
- chronic poisoning of the body resulting from the use of alcoholic beverages, tobacco smoking, work in hazardous production, associated with the inhalation of lead vapors;
- improper organization of food and consumption of harmful products;
- chronic hypovitaminosis, manifested in an acute shortage of provitamin A and B vitamins;
- of hereditary and neurogenic factors;
- infectious diseases( salmonellosis, typhoid, viral hepatitis, dysentery);
- increased susceptibility of the organism to the effects of food allergens, provoking increased permeability of the gastric mucosa.
There is a theory that the menetria are responsible for the development of the disease, diseases and conditions provoking a violation of the integrity of the gastric mucosa( malformations, inflammatory and tumor processes of a benign nature).
Under the influence of the above pathologies, the processes of growth of glandular tissues and mucoid( mucoid) cells start in the structures of damaged mucous membranes. After a while, becoming diffuse, these processes begin to spread both deep inside and on the surface of the affected tissues.
Symptoms of the disease Menetries
Depending on which symptom complex is predominant, the giant-gastritis gastritis can be:
- Dyspeptic. In this type of Menetria disease, complaints predominate in patients concerning disorders of the digestive process.
- Pseudotumoral. This variant of pathology is characterized by a feeling of weakness, a significant deterioration in the general condition, a significant decrease in body weight.
- Asymptomatic. This rare type of disease - due to the absence of external manifestations - is discovered quite accidentally during the performance of surgical operations or diagnostic studies designed to identify completely different pathologies.
Increase in clinical symptoms occurs gradually.
- A general blood test will indicate a decreased level of hemoglobin and a decrease in the number of red blood cells, due to the large number of minor blood loss, which rarely leads to the development of severe anemia. Some patients have neutrophilic leukocytosis - a condition accompanied by a high content of neutrophils( a special kind of leukocytes) in the blood.
- Biochemical blood test reveals a low level of albumin( the most significant protein fraction in the blood serum).To determine the cause of hypoalbumism, noted in 80% of patients, a series of special studies was conducted. Labeled albumin was injected intravenously into the body of the participants in the experiment. After a while it was found in the gastric juice. Thus, it was proved that the loss of proteins with digestive juice is due to the high permeability of the mucous membranes of the stomach. However, not all gastroenterologists consider hypoproteinemia to be a characteristic manifestation of gigantoscladic gastritis. They are convinced that an abnormally low level of albumin in the blood serum is detected only in patients with obvious swelling.
- When determining the acidity of gastric juice, a hypoacid condition is revealed, in which the body is unable to secrete the necessary amount of gastric juice due to atrophy of the lining cells producing hydrochloric acid and digestive juice.
- X-ray examination is a more informative technique that helps the treating specialist to get an idea of the nature of the changes occurring in the patient's organism and to attribute the pathology to one of two forms - limited or widespread. The limited form of the giant-edged gastritis appears in the pictures as a heap of tortuous thick folds protruding into the lumen of the stomach. A typical site of their localization in Menetries disease is a site of great curvature of the stomach. The widespread form of adenopapillomatosis is characterized by the presence of similar changes in the gastric mucosa over a considerable extent( mainly in the vault, sinus and body of the stomach), with the exception of the antral section having normal folds.
- In modern clinics for diagnosing Menetries disease, radiographs of the stomach with double contrasting are performed, which involves filling the test organ with radiopaque substance( barium sulfate) and gas. Before passing the procedure, the patient is offered to drink a barium suspension through a tube, in the walls of which holes are made, through which air enters the stomach. Having massaged the anterior abdominal wall, the radiologist achieves a uniform distribution of the radiopaque substance in the folds of the mucous membranes of the stomach, and with the help of air it is possible to straighten these folds to carefully examine their relief. During the procedure, several images are taken in the lateral, anteroposterior and oblique projections. The method of contrast radiography makes it possible to distinguish Menetries disease from stomach cancer.
- No less objective picture of the characteristic changes in the gastric mucosa is provided by the endoscopic examination technique - fibrogastroscopy performed with the help of a special device - an esophagogastroscope( a flexible tube equipped with a flashlight and a miniature video camera).During examination of the mucous membranes in the patient suffering from Menetria disease, thick folds are clearly visible, the outlines of which resemble brain convolutions or the surface of a cobblestone pavement. The folds of the gastric mucosa are for the most part edematic and pale, sometimes hyperemic. Due to the extreme vulnerability of the mucosa in the upper part of the folds, whose height is not less than two centimeters, there are many erosions. During the procedure of endoscopic examination, the dosed inflating of the stomach with air is often resorted to, allowing one to detect the presence of giant folds that do not straighten even when creating a strong( above 15 mm Hg) pressure inside the organ under examination. This makes it possible to distinguish the Menetries disease from the usual hypertrophic gastritis.
- The aspiration biopsy procedure is performed to select samples from a large area of pathologically altered mucosa for a variety of laboratory tests that confirm the presence of multiple cysts and heavily enlarged glands. The great advantage of this technique is the possibility of obtaining samples from deep layers of the mucosa containing gastric glands, which increases the reliability of the results of histology. The main disadvantage of blind aspiration biopsy is a large number of errors due to the fact that the material for research is often taken from sites that have not been affected by the pathological process.
- As a rule, all patients in the epigastric region and in the upper abdomen have severe pains( mostly noisy) that occur after eating and are associated with a feeling of heaviness in the stomach and a feeling of overflow. Duration and intensity of pain can be different.
- For the majority of patients, vomiting, repeated gastric bleeding and diarrhea are common. Vomiting that occurs after eating at the peak of a painful seizure associated with it, brings relief and relief to the patients for a short time. In every fifth case, vomit contains a small amount of blood. Gastric bleeding - due to low intensity - rarely causes anemia.
- One of the most important diagnostic signs of the disease is rapid weight loss: for a fairly short period of time, a patient who has not changed his eating habits can lose ten to twenty kilograms.
- Loss of appetite, due to the presence of severe and persistent pain and fraught with the development of anorexia, is quite rare.
- Because of protein deficiency caused by a decrease in the level of proteins in the blood serum, peripheral edema of the face, abdomen, upper and lower extremities develop in some patients.
- Blood levels are characterized by a moderate decrease in hemoglobin, the number of red blood cells and leukocytes, while ESR and platelet count continue to meet age requirements.
A number of leading gastroenterologists are inclined to refer Menetries disease to the category of precancerous states, arguing their point of view by the fact that against this background, often( in 20% of cases) develops adenocarcinoma of the stomach.
Opponents of these specialists consider this theory to be untenable, because the cause-and-effect relationships of giganto-gastritis gastritis and gastric cancer have no histological confirmation.
Diagnosis of the disease
Diagnosis of the disease Menetries begin with a physical examination of the patient and a thorough analysis of his complaints. After a history of a series of laboratory and instrumental studies:
The main purpose of taking a biopsy with a suspicion of Menetriae disease is the need for differential diagnosis, which makes it possible to distinguish it from a number of serious ailments, the most formidable of which is stomach cancer.
If there is a suspicion of a malignant tumor of this organ, a second examination of the patient is carried out four to six weeks later.
In particularly alarming cases, immediate trial laparotomy is used. A biopsy taken during this operation makes it possible to obtain enough material for an accurate diagnosis.
Treatment of pathology
The treatment scheme for giant hypertrophic gastritis depends on the severity of the pathology.
In order to save the patient from mild forms of Menetriae's disease, they resort to conservative treatment involving the use of drugs with enveloping and astringent action. The patient is assigned:
- "Maalox".
- Almagel.
- "Fosfalugel".
In the course of substitution therapy for patients with low gastric acidity( in addition to natural gastric juice and a solution of( 1%) hydrochloric acid with the addition of pepsin), the following preparations are recommended:
- "Panzinorm".
- Plantaglucid.
- "Polizim".
- "Abomin".
- "Meksaz".
In the presence of digestive disorders, patients are treated with enzyme preparations:
- pancreatin;
- with mesim;
- Creon.
To reduce the level of protein deficiency, thereby achieving a significant improvement in the overall condition of patients, they are prescribed atropine.
The food given to patients should be gentle: both mechanically, and thermally, and chemically. Patients should give up too sharp, fatty and fried foods. It is also necessary to refrain from using them in excessively hot or cold form.
In patients with severe menethric syndrome characterized by severe pain syndrome, frequent gastric bleeding and significant edema caused by an acute shortage of proteins, the patients are shown to have an operative treatment providing for gastrectomy( partial or complete), a surgical operation consisting of removal of the stomach and the application of anastomosis.
Tissues taken during the biopsy are necessarily subjected to a laboratory test.
Patients with a giant gastritis should be on a dispensary record with a gastroenterologist. Control radiography and procedure of fibrogastroscopy - to monitor the dynamics of the disease - they need to be held at least twice a year. Laboratory blood tests are also necessary.
Prognosis and prevention
Prognosis of the disease Menetrie is relatively favorable, although it significantly reduces the quality of life of the patient. Giant-latric gastritis can occur for a number of years without serious complications.
It is established that the nature of the prognosis is affected by the timeliness of the diagnosis and the immediate appointment of adequate therapy: the earlier they are implemented, the better the prognosis will be.
In the clinical course of the disease, there are periods of prolonged remission;in a number of cases the giant-gastritis gastritis can pass into an atrophic form, at which the serum albumin level is restored to normal values.
In the environment of specialists there is an assumption about the presence of the connection of the giant-gastritis gastritis with the subsequent development of gastric adenocarcinoma. A large group of gastroenterologists consider Menetria's disease a background condition for degeneration into a malignant tumor.
Since the etiology of the giant-gastritis gastritis is still not clear, there is no specific prophylaxis of this ailment. Methods of secondary prevention of Menetries disease should be considered necessary:
- to maintain a consistent diet;
- regular visits to the gastroenterologist for the purpose of passing a preventive examination.