Hypertrophic gastropathies: Ménétrier, Zollinger–Ellison
- Lesion
In these rare diseases the stomach folds become giant because growth signals make the lining overgrow, not because of inflammation.
What it is
Hypertrophic gastropathies give the stomach giant, brain-like (cerebriform) rugal folds from epithelial hyperplasia with little inflammation. Both examples come from too much growth signal. In Ménétrier disease, excess TGF-α overstimulates the EGF receptor of foveolar cells, which overgrow and leak protein. In Zollinger–Ellison syndrome, a gastrin-secreting neuroendocrine tumour drives parietal-cell hyperplasia and acid hypersecretion.
Structure
- Ménétrier: giant rugae in the body and fundus; foveolar hyperplasia with elongated, tortuous, cystically dilated glands.
- Zollinger–Ellison: rugal enlargement from a thickened oxyntic layer packed with parietal cells.
The two hypertrophic gastropathies
| Feature | Ménétrier disease | Zollinger–Ellison syndrome |
|---|---|---|
| Signal | TGF-α activating EGF receptor | Gastrin from a neuroendocrine tumour |
| Cell that overgrows | Foveolar mucous cells | Parietal cells (also mucous neck and ECL cells) |
| Glands | Elongated corkscrew pits, cysts; oxyntic glands may be atrophic | Thick oxyntic mucosa full of parietal cells |
| Acid | Low or normal | Very high |
| Main problem | Protein loss, oedema, weight loss, diarrhoea | Severe peptic ulcers, diarrhoea |
| Cancer link | Gastric adenocarcinoma in adults | Malignant gastrinoma; MEN1 |
Clinical notes
- Gastrinoma is located by somatostatin receptor imaging or endoscopic ultrasound; acid suppression protects while the tumour is treated.
- Raised fasting gastrin with high acid output separates Zollinger–Ellison from achlorhydric causes of high gastrin.
Test yourself
Think of the answer, then tap the question to see it.
Which growth factor is overproduced in Ménétrier disease?
Transforming growth factor alpha, which activates the epidermal growth factor receptor of foveolar cells.
Which cell type is hyperplastic in the stomach of Zollinger–Ellison syndrome?
The parietal cell, driven by gastrin from a gastrinoma.
Which inherited syndrome accounts for about a quarter of gastrinomas?
Multiple endocrine neoplasia type 1 (MEN1).
Elsewhere in DurgiPedia
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Zollinger-Ellison syndrome: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2025); Peptic Ulcer Disease (StatPearls (NCBI Bookshelf), 2025).
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Representative model, for educational purposes only.