• All have hyperrugosity or enlarged folds, usually in the body and fundus of stomach

• Coarse duodenal folds are usually associated with large folds in the stomach

• Most often, enlarged gastric folds are normal

• Factors which suggest large folds are pathologic

        • Nodularity or induration of the fold

        • Asymmetry or segmental distribution

         • Wall rigidity

         • Ulceration

Types of Hypertrophic Gastropathies

• Zollinger-Ellison Syndrome

      • Hypersecretion of gastric acid 2° gastrinoma non-b islet cell tumor

           • Pancreas (87%), medial wall of duodenum (13%)

              • Most are malignant (60%)

              • Clinical tetrad of

               1) Gastric Hypersecretion

• X-ray suggested by         

               1) Multiple ulcers (10%), most in bulb, but also post-bulbar, jejunum

               2) Recurrent ulcers

               3) Marginal ulcers in post-gastrectomy patients

                     a) On gastric side

                     b) Mesenteric border of efferent loop

 • Hypertrophic hypersecretory gastropathy

            • Hypersecretion of gastric acid

 • Hypertrophic hypersecretory gastropathy with protein loss

            • Hypersecretion of gastric acid

 • Menetrier’s Disease-fundus and body, esp. greater curvature

            • Low acid output-hypochlorhydria

                • Hypoproteinemia 2° GI protein loss

                       • Peripheral edema

                • Mostly middle-aged men

                • Associated with benign gastric ulcer (13-72%)

                       • GI bleeding

• Carcinoma occurs in 10%, the same number as those patients who have atrophic gastritis and carcinoma

• DDx: Lymphoma (involves antrum which Menetrier’s does not), gastric carcinoma, gastritis, gastric varices