- Overview
- Hypoproteinaemic Hypertrophic Gastropathy
- Rare, acquired disease, Pre-malignant
- Characterised by massive gastric folds in the fundus and body
- Gives mucosa cobblestone or cerebriform appearance (looks like brain!)
- Pathology
- Foveolar Hyperplasia
- Expansion of surface mucous cells, and loss of parietal cells
- Typical changes seen on endoscopy
- Protein loss from the stomach
- Excessive mucus production
- Hypo or achlorhydria (gland atrophy)
- Aetiology
- Unknown - ? CMV infection in children, ? H.Pylori in adults
- Presentation
- Epigastric pain, vomiting, weight loss, anorexia, peripheral oedema
- Investigations
- Gastroscopy and biopsy to R/O gastric carcinoma or lymphoma
- Can do 24hr pH monitoring to detect low acid levels
- Management
- Anticholinergics, PPIs, Octreotide, H.pylori eradication
- Inconsistent results
- Consider total gastrectomy if
- Massive ongoing protein loss despite medical therapy
- Dysplasia or carcinoma on biopsy