Introduction

• Uncommon.
• Cause: possibly excessive hormonal trophic factors, eg gastrin → focal, localized, eg pylorus obstruction or diffuse thickening of gastric mucosa. Reaction to foreign body, gastrinoma.
• Signs: vomiting of variable character with or without blood.
• Diagnosis: gastroscopy and histopathology; laparotomy and histopathology. Often normal biopsies with endoscopy. Laprotomy to get submucosa/muscle in biopsy.
• Treatment: treat underlying cause or symptomatic.
• Prognosis: depends on finding and eliminating the underlying cause.

Pathogenesis

Etiology

• Unknown.
• Excess hormonal trophic factors, eg:
  • Gastrin, histamine or acetylcholine - chronic hypertrophic gastritis in Basenji may be associated hypergastrinemia.
  • Also recognized with gastrinomas (Zollinger-Ellison syndrome) (pancreatitis, cell neoplasia).
  • Systemic mast cell neoplasia Skin: mastocytoma may also predispose to hypertrophy.
• Chronic irritation: either mechanical foreign body or inflammatory.
• Immune-mediated.
• Stress.
• Idiopathic.

Specific

• Gastrinoma Pancreas: neoplasia: gastrinoma , eg hypergastrinemia/renal failure/Basenji enteropathy.
• Systemic mast cell neoplasia Skin: mastocytoma.
• Stress.
• Gastric outflow obstruction by foreign object.

Pathophysiology

• May present as:
  • Focal disease - pyloric obstruction.
  • Diffuse disease - fundus.
  • Polypoid - antrum.
• Glandular submucosal and/or muscular hypertrophy due to chronic stimulation associated with foreign body, gastrin, histamine excesses.
• Chronic proton pump blocker (omeprazole Omeprazole ) adminstration.
• Hypertrophy of parietal, mucus and chief cells → damage to mucosal barrier → back diffusion of hydrochloric acid and pepsin → inflammation and superficial ulceration.

Diagnosis

Treatment

Outcomes