Ménétrier's disease presenting with melena and severe anemia in the absence of hypoalbuminemia: A case report

Ménétrier's disease (MD), an uncommon protein-losing gastropathy characterized by hypertrophic gastric folds, primarily affects individuals in their 30 s to 60 s. We present a case of MD in a 69-year-old female with atypical symptoms of melena, fatigue, and lightheadedness. Admission revealed severe anemia with a hemoglobin of 5.1 g/dL (Females: 12.0 to 15.5 g/dL). Esophagogastroduodenoscopy (EGD) demonstrated markedly hypertrophied gastric folds with mucoid secretions, elevated serum gastrin levels of 339 pg/mL (0 to 180 pg/mL). Pathology confirmed MD, revealing characteristic mucosal changes without significant inflammation or H. pylori. Menetrier's disease is a rare disorder with a low incidence, affecting less than 1 in 100,000 people. The disease is characterized by thickened gastric mucosa, with Middle-aged men having a higher prevalence. The disease is diagnosed with foveolar hyperplasia, and no antibiotic therapy is offered. The trigger for the disease is unclear, but studies have linked it to subclinical viral infections and genetic links. The disease is caused by an increase in the signaling of the epidermal growth factor receptor (EGFR), leading to increased mucus production and decreased acid production. The patient presents with melena, edema, vomiting, anorexia, diarrhea, and rarely gastric intussusception. The patient is initially treated conservatively with PPI and a high-protein diet, with plans to try Cetuximab if hypoalbuminemia and melena persist. Diagnosing rare diseases like Menetrier's disease requires thorough examination and treatment. Treatment and surveillance guidelines are often influenced by gastroenterologists, and providers must stay updated on pathophysiology and current treatments. Complications, such as protein loss, should be managed with protein supplements, and patients should be monitored for potential malignancy. • Mentrier’s disease as a differential diagnosis for melena • Pathophysiology, epidemiology, and presentation of the disease • Newer treatment options for Menetrier’s disease • Differential diagnosis to exclude while evaluating the disease