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# 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.

Updated Nov 12, 2026

## Key points

- Ménétrier: foveolar (mucous cell) hyperplasia of body and fundus, antrum spared; protein-losing gastropathy with hypoalbuminaemia and oedema; higher adenocarcinoma risk in adults.
- In children Ménétrier is often self-limited after CMV infection.
- Zollinger–Ellison: gastrinoma in the duodenum or pancreas; thick oxyntic mucosa from parietal-cell hyperplasia.
- Zollinger–Ellison presents with multiple, refractory or unusually placed ulcers (distal duodenum, jejunum) and diarrhoea.
- About a quarter of gastrinomas occur in MEN1; these are smaller, multiple and duodenal; most gastrinomas are malignant.

## 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](https://durgical.com/en/conditions/menetrier-disease/) | 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](https://durgical.com/en/conditions/zollinger-ellison-syndrome/) | 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.

## Memory aid

Ménétrier makes mucus cells and loses protein; Zollinger makes acid and ulcers.

## 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).

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## Elsewhere in DurgiPedia

- [Gastrointestinal hormones](https://durgical.com/en/physiology/gastrointestinal-hormones/)
- [Gastric acid secretion](https://durgical.com/en/physiology/gastric-acid-secretion/)

## Connections

## Related 4

- [Peptic ulcer](https://durgical.com/en/general-pathology/peptic-ulcer/)
- [Gastrointestinal neuroendocrine (carcinoid) tumours](https://durgical.com/en/general-pathology/gastrointestinal-neuroendocrine-tumours/)
- [Gastric polyps](https://durgical.com/en/general-pathology/gastric-polyps/)
- [Hyperplasia: physiologic and pathologic](https://durgical.com/en/general-pathology/hyperplasia-physiologic-and-pathologic/)

## Related conditions 6

- [Ménétrier disease (hypertrophic protein-losing gastropathy)](https://durgical.com/en/conditions/menetrier-disease/)
- [Zollinger-Ellison syndrome (gastrinoma)](https://durgical.com/en/conditions/zollinger-ellison-syndrome/)
- [Multiple endocrine neoplasia (MEN 1, 2A, 2B)](https://durgical.com/en/conditions/multiple-endocrine-neoplasia/)
- [Peptic ulcer disease](https://durgical.com/en/conditions/peptic-ulcer-disease/)
- [Pancreatic neuroendocrine tumours (VIPoma, glucagonoma, somatostatinoma, non-functioning)](https://durgical.com/en/conditions/pancreatic-neuroendocrine-tumours/)
- [Cytomegalovirus infection](https://durgical.com/en/conditions/cytomegalovirus-infection/)

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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](https://medlineplus.gov/ency/article/000325.htm) (MedlinePlus, US National Library of Medicine, 2025); [Peptic Ulcer Disease](https://www.ncbi.nlm.nih.gov/books/NBK534792/) (StatPearls (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/hypertrophic-gastropathies-menetrier-zollinger-ellison/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/hypertrophic-gastropathies-menetrier-zollinger-ellison/