A Trial of Medical Treatment with Propantheline Bromide and Cimetidine for Ménétrier's Disease, Report of a Case Tsutomu Ishida 1 , Akira Suzuki 1 , Matatoshi Tateno 2 , Jun Yamaguchi 2 , Mutsuo Mizukoshi 3 1Department of Internal Medicine (Section 3), Sapporo Medical College 2Department of Pathology, Sapporo City General Hospital 3Department of Internal Medicine, Sapporo City General Hospital pp.527-532
Published Date 1985/5/25
DOI https://doi.org/10.11477/mf.1403109843
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 A 29 year-old woman was admitted to our hospital in May 1981, complaining of palpitations and edema of the face and lower extremities. Laboratory studies revealed hypoproteinemia with a level of 4.2 g/dl, iron deficiency anemia (RBC 339×104/mm3,Hb 4.7 g/dl,Ht 16.6%, serum iron 23 μg/dl), hypocalcemia, a normal urinalysis, and stools which were positive for occult blood. X-ray and gastroscopic examinations of the stomach showed giant rugae with granular surface from the lower part of the corpus to the fundus, and mucosal atrophic change in the antrum. A mucosal biopsy of tissue from the fundic giant folds revealed hyperplasia of the foveolar epithelium and infiltration of plasma cells and neutrophils. 131I-HSA losing % was 6.4.

 From these findings, we diagnosed this case as Ménétrier's disease with hypoproteinemia.

 Initially, antifibrinolytic therapy with oral tranexamic acid was performed, but it was totally ineffective. Therefore, an administration of 75 mg/day of propantheline bromide was given. During the two-month period of propantheline treatment, the total serum protein value increased significantly (p<0.005) from 4.8±0.26 to 5.5±0.21 g/dl. Following this twomonth period, 75 mg/day of propantheline was combined with 600 mg/day of cimetidine. During the period of combination therapy, the total serum protein value rose to 6.2±0.31 g/dl, which was statistically significant (p<0.01), as compared to the value achieved during the propantheline treatment period.  As the patient had improved both subjectively and objectively, only 800 mg/day of cimetidine was administered from May 1982. And, though the total-serum protein value decreased gradually for eight months, it has showed a remarkable increase from January 1983, and now keeps completely stable value. The findings of x-ray and gastroscopic examinations of the stomach in August 1983 showed remarkable changes The thickened gastric wall and the size of the stomach have become normalized, the giant rugae and the convexo-concave pattern on the surface of the folds and the valley between folds have disappeared.

 At the present time, the patient leads a completely normal life with administration of 800 mg/day of cimetidine alone. Our experience with this patient leads us to advocate propantheline and cimetidine therapy for the patient of Ménétrier's disease with hypoproteinemia before resorting to gastrectomy.

Copyright © 1985, Igaku-Shoin Ltd. All rights reserved.


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