Abstract
Objective:
Childhood Ménétrier disease (MD) is an extremely rare protein-losing gastropathy. This case report and systematic literature review aimed to characterize the clinical presentation, diagnosis, treatment, and outcomes of MD in Chinese children, using a well-documented institutional case and all eligible published Chinese pediatric cases.
Methods:
We retrospectively analyzed one confirmed pediatric MD case admitted to our institution in January 2020. A systematic literature search of PubMed, CNKI, and Wanfang Data was conducted from database inception to January 2026. Eligible publications were single-patient case reports, brief case/image reports, or case-based articles describing Chinese patients younger than 18 years with endoscopic and histological evidence consistent with MD. The quality of included reports was evaluated using the JBI Critical Appraisal Checklist, and descriptive statistics were applied to the aggregated cohort of 16 patients.
Results:
The index case presented with abdominal pain, edema, polyserositis, severe hypoalbuminemia, giant gastric folds, and histological foveolar hyperplasia. Symptoms resolved after conservative management. The systematic review identified 15 additional eligible published cases, yielding 16 Chinese pediatric patients in total (68.8% male). The median age at presentation/diagnosis was 10.0 years, and most patients were school-aged children or adolescents. Core manifestations included abdominal pain (75.0%), edema (75.0%), and vomiting (62.5%). Hypoalbuminemia was documented in 87.5% of patients, with a median serum albumin level of 20 g/L. Endoscopy consistently showed hypertrophic gastric mucosa, with gastric body involvement in all cases. Histological findings were dominated by foveolar epithelial hyperplasia, tortuous or cystically dilated glands, and variable oxyntic gland atrophy. Among the 12 patients with documented conservative treatment, all achieved improvement or remission. The median time to symptomatic relief was 22 days, whereas endoscopic normalization required a median of 4.5 months.
Conclusion:
This case report with a systematic review indicates that pediatric Ménétrier disease in China has recognizable clinical, endoscopic, and histological features. It mainly affects school-aged boys and adolescents. Abdominal pain, edema, vomiting, and hypoalbuminemia are key clues. Diagnosis requires endoscopy and histopathology, while conservative treatment generally achieves favorable outcomes despite delayed mucosal recovery.
1 Introduction
Ménétrier disease (MD) is a rare, acquired premalignant protein-losing gastropathy characterized by diffuse hypertrophy of the gastric mucosal folds, massive foveolar hyperplasia, and atrophy of the oxyntic glands (). The pathogenesis remains incompletely understood but is fundamentally driven by the overexpression of transforming growth factor-alpha (TGF-α) and the subsequent overactivation of the epidermal growth factor receptor (EGFR) signaling pathway (). While the disease primarily afflicts the adult population, where it follows a chronic, progressive course with a notable risk of malignant transformation to gastric cancer (), pediatric MD is exceedingly rare and exhibits a distinctly different clinical trajectory.
In children, MD is typically characterized by an acute onset and a self-limiting course. It is frequently triggered by antecedent infections, most notably Cytomegalovirus (CMV) () and Helicobacter pylori (Hp), though other atypical agents like Epstein–Barr virus (EBV) () and Mycoplasma pneumoniae () have been occasionally implicated. The classic clinical features of pediatric MD include gastrointestinal symptoms, peripheral edema, and severe hypoalbuminemia resulting from a protein-losing gastropathy, where serum proteins are exuded across the hypertrophic gastric mucosa (). However, the heterogeneity of clinical phenotypes often leads to misdiagnosis or delayed treatment. Current literature on pediatric MD consists predominantly of isolated case reports and small case series, lacking large-scale epidemiological data ().
Particularly in the Chinese pediatric population, reports are scattered, and there is a critical absence of systematically aggregated cohort characteristics. To further elucidate the clinical profile of this rare condition, and elevate the methodological rigor of current evidence, this study was designed in accordance with the international writing standards of the EQUATOR Network. We detail a comprehensively documented pediatric MD case from our institution (following the CARE guidelines) and perform a systematic review of all reported domestic cases adhering to the PRISMA guidelines. By consolidating these data and evaluating the risk of bias, we aim to systematically summarize the epidemiological, clinical, and pathological features of MD in Chinese children, thereby optimizing the diagnostic algorithm and therapeutic strategies for this rare entity.
2 Clinical data and methods
2.1 Study design and guidelines
This study combines an institutional clinical case report with a comprehensive systematic review. The case report component was drafted in strict accordance with the CARE (CAse REport) guidelines () to ensure accuracy and clinical transparency. Concurrently, the systematic literature review was conducted and reported strictly following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines ().
2.2 Institutional case
The institutional case was a confirmed pediatric MD case admitted to our institution in January 2020. Clinical information was retrospectively collected from the medical records, including history, physical examination, laboratory and imaging findings, endoscopic and histopathological results, treatment, and follow-up data extending to 6 years.
2.3 Systematic review search strategy and selection criteria
A systematic and structured search was performed across PubMed, China National Knowledge Infrastructure (CNKI), and Wanfang Data from database inception to January 2026. The specific search terms utilized were “儿童Ménétrier病” OR “巨大胃黏膜肥厚症” (in Chinese databases) and “Pediatric Ménétrier Disease” OR “Childhood Ménétrier Disease” OR “Hypertrophic Gastropathy” (in PubMed). Inclusion criteria were defined as follows: (1) age <18 years; (2) endoscopic evidence demonstrating markedly enlarged, thickened gastric folds; (3) histopathological confirmation of gastric mucosal thickening, foveolar/glandular hyperplasia, or compatible hypertrophic gastropathy; and (4) patients of Chinese descent. The eligible literature consisted of single-patient case reports, brief case/image reports, and case-based articles; no comparative cohort studies or trials were available. Exclusion criteria included: (1) duplicate publications or overlapping cohorts; (2) adult patients; (3) incomplete baseline characteristics, treatment, or outcome data; and (4) insufficient histological information. The detailed literature screening process was documented using a standard PRISMA flow diagram.
2.4 Quality assessment and data extraction
To minimize publication bias and ensure the quality of evidence, two independent reviewers assessed the risk of bias for the included case reports using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports (). A standardized data extraction spreadsheet was established to collect: (1) Epidemiological characteristics (gender, onset age); (2) Clinical symptoms and signs (initial symptoms, core symptoms, extraintestinal complications); (3) Auxiliary examinations (laboratory tests including albumin levels, infection markers, endoscopic features, pathological findings, and radiological imaging); (4) Misdiagnosis history; (5) Treatment strategies; and (6) Follow-up outcomes (total duration, time to symptom relief, and time to endoscopic normalization). Continuous variables with a non-normal distribution were presented as medians with interquartile ranges (IQR), while categorical variables were presented as frequencies and percentages.
3 Results
3.1 Detailed clinical case from our institution
3.1.1 Clinical presentation
A 3-year-and-6-month-old boy was admitted to our gastroenterology department in January 2020 with an 8-day history of cough and a 6-day history of abdominal pain and lethargy. The illness initially presented with cough, low-grade fever, periumbilical pain, and poor spirit. Initial outpatient laboratory tests revealed leukocytosis, severe hypoalbuminemia (14.5 g/L), and hyponatremia (123 mmol/L). An empiric treatment regimen of amoxicillin-clavulanate potassium and cimetidine for 4 days partially alleviated his cough, but the abdominal pain and lethargy persisted without improvement, prompting his transfer to our facility. The patient had a previously healthy background with no history of food or drug allergies, nor any family history of gastrointestinal diseases. Since the onset of the illness, his oral intake had decreased by approximately half, but his body weight remained stable without significant loss.
3.1.2 Physical examination
Vital signs upon admission were: T 37.3 °C, P 104 bpm, R 28 breaths/min, BP 110/65 mmHg, and body weight 15 kg. The patient was conscious but exhibited a poor mental response. The abdomen was distended but lacked tenderness, rebound tenderness, or muscle guarding. Neither the liver nor the spleen was palpable below the costal margin, and bowel sounds were normoactive. Mild pitting edema was noted on both hands and lower extremities. No other significant abnormalities were found during the physical examination.
3.1.3 Laboratory and imaging findings
The initial work-up demonstrated marked hypoalbuminemia and serosal effusions, supporting protein-losing gastropathy as the dominant clinical problem. Blood testing showed leukocytosis (WBC 12.3 × 10⁹/L) with eosinophilia (9.9%; absolute count, 1.22 × 10⁹/L), normal hemoglobin and platelet counts, and normal C-reactive protein and procalcitonin levels. Biochemistry revealed a total serum protein level of 24.9 g/L and a critically low serum albumin level of 14.1 g/L, whereas electrolytes, coagulation profile, liver and kidney function, myocardial enzymes, tumor markers, thyroid function, routine urinalysis, and 24-hour urinary protein were unremarkable. Fecal occult blood was positive. Screening for Mycoplasma pneumoniae, HAV, HBV, HCV, HIV, syphilis, tuberculosis, CMV, and Hp did not identify an active infectious trigger. Echocardiography showed minimal pericardial effusion, abdominal CT showed intestinal wall edema with massive ascites and abdominal wall exudation, and chest CT showed bilateral pneumonia with pleural effusions. Ascitic fluid was transudative and negative for acid-fast staining, TB-DNA, and bacterial culture.
3.1.4 Endoscopy and histology
Gastroscopy revealed markedly thickened, swollen, and tortuous mucosal folds in the gastric fundus (Figure 1A). The mucosa of the gastric body exhibited prominent hyperemia, edema, and giant folds with multiple patchy erosions covered by copious mucus (Figure 1B). By contrast, the gastric antrum and duodenum showed no obvious hypertrophy or erosive lesions (Figure 1C). Histological examination of gastric body biopsies demonstrated thickened mucosa with pronounced foveolar epithelial hyperplasia, elongated and partially cystically dilated glands, and a marked reduction in oxyntic glands (Figure 2A). Prominent eosinophil infiltration [15–218 eosinophils/high-power field (HPF)] was also observed in the lamina propria of the gastric body (Figure 2B). The gastric antral biopsy specimen showed foveolar/glandular hyperplasia with tortuous and branched glands and mild stromal edema, without convincing oxyntic mucosa in the displayed field (Figure 2C). No area with more pronounced polypoid foveolar hyperplasia was identified in the available biopsy sections. Immunohistochemical stains for CMV and Hp were both negative.
Figure 1
Figure 2
3.1.5 Diagnosis, treatment, and follow-up
Based on severe hypoalbuminemia, polyserositis, and abdominal pain, together with classic endoscopic and histological alterations, the patient was diagnosed with MD. The treatment regimen consisted of cefathiamidine for infection control, omeprazole (1 mg/kg/d) for acid suppression, aluminum phosphate gel for gastric mucosal protection, and enteral nutritional support. Intravenous human albumin was administered 7 times (8–10 g/dose) to rapidly correct the hypoalbuminemia. A closed thoracic drainage was performed on admission day 4 and successfully removed 6 days later. After 2 weeks of treatment, the patient became afebrile, abdominal pain completely resolved, appetite normalized, and the peripheral edema subsided. His serum albumin level rose to 29.2 g/L.
The patient was discharged with dietary instructions emphasizing high protein intake. Two months post-discharge, his serum albumin increased to 38.3 g/L, and follow-up gastroscopy showed only residual clustered or nodular mucosal protrusions without active mucus, erosion, or exudation. Concomitant biopsies indicated restoration of oxyntic glands and markedly reduced eosinophilic infiltration. By the 8-month follow-up visit, gastroscopy demonstrated complete morphological normalization of the gastric fundus, body, and antrum. A long-term clinical follow-up extending to 6 years confirmed normal growth and development with no disease recurrence.
3.2 Systematic analysis of 16 Chinese pediatric MD cases
The systematic literature search and rigorous screening process resulted in the inclusion of 15 articles (, –) reporting 15 pediatric cases, which, when combined with our institutional case, formed an aggregated cohort of 16 patients for descriptive analysis (Figure 3; Supplementary Table 1).
Figure 3
3.2.1 Epidemiological characteristics
Within the aggregated cohort of 16 children, there were 11 males (68.8%) and 5 females (31.2%), yielding a male-to-female ratio of 2.2:1. The median age at presentation/diagnosis was 10.0 years (IQR: 4.7–14.0 years). Notably, there were no cases younger than 3 years. Seven cases (43.8%) were aged 3–6 years, while the majority, 9 cases (56.2%), were diagnosed in the school-age and adolescent stages (>6–18 years), highlighting this demographic as the high-risk population in China.
3.2.2 Clinical symptoms and signs
Abdominal pain was the most prevalent core symptom, affecting 12 cases (75.0%). This was closely followed by peripheral edema (12 cases, 75.0%) and vomiting (10 cases, 62.5%). Additional manifestations included diarrhea (25.0%), anorexia (25.0%), anemia (25.0%), gastrointestinal bleeding (18.8%), and growth retardation (12.5%). In terms of initial presentations, abdominal pain led (43.8%), followed by edema and vomiting (both 25.0%). Intriguingly, 1 patient (6.3%) presented exclusively with isolated edema, completely devoid of typical gastrointestinal complaints. Serous cavity effusion was documented in 7 cases (43.8%), which included isolated ascites, concurrent ascites and pleural effusion, and one case featuring a combination of ascites, pleural effusion, and pericardial effusion.
3.2.3 Auxiliary examinations
Severe hypoalbuminemia was the biochemical hallmark, documented in 87.5% of the cohort (14/16). Among the 14 cases with specific data, the median serum albumin level was 20 g/L (IQR: 17.1–25.5 g/L), noting that one reported child had a normal albumin level. Hematological evaluations revealed peripheral eosinophilia in 3 cases (18.8%). Infectious screening identified CMV-IgM positivity in 3 cases (18.8%), Hp positivity in 3 cases (18.8%), and EBV-encoded small RNA (EBER) positivity in 1 case (6.3%). No cases of multiple co-infections were reported. Endoscopically, 100% of the patients exhibited diffuse, cerebriform, or nodular hypertrophy of the gastric mucosal folds that resisted flattening upon insufflation. The hypertrophy predominantly involved the gastric body (16 cases, 100%) and the gastric fundus (13 cases, 81.3%), while the antrum (50.0%) and duodenum (18.8%) were less frequently affected. Histopathologically, the core alterations included foveolar epithelial or glandular hyperplasia (68.8%), accompanied by the downward elongation, tortuosity, or cystic dilation of foveolar glands (50.0%), and marked atrophy of the oxyntic glands (37.5%). None of the pediatric cases exhibited atypical hyperplasia or malignant transformation.
3.2.4 Treatment and outcomes
All 12 patients with comprehensive therapeutic records underwent conservative medical management, and none required surgical intervention. The treatment modalities primarily included proton pump inhibitors (83.3%) and intravenous human albumin supplementation (83.3%). Pathogen-specific therapies were administered selectively, including Hp eradication in 3 cases (25.0%) and antiviral therapy in 2 cases (16.7%). Across follow-up periods ranging from 22 days to 6 years, all 12 patients (100%) achieved clinical improvement or remission without reported relapses. For those with documented timelines, the median time to achieve symptomatic relief was 22 days (IQR: 16.3–52.5 days), while the median time for endoscopic normalization was substantially longer, at 4.5 months (IQR: 2.25–6.0 months).
4 Discussion
Ménétrier disease is a rare protein-losing gastropathy first described by Pierre Ménétrier in 1888 (). The pathogenesis is intricately linked to the overexpression of transforming growth factor-alpha (TGF-α), which binds to the epidermal growth factor receptor (EGFR). This hyperactivation triggers massive proliferation of mucous-secreting foveolar cells at the expense of acid-secreting parietal cells, resulting in thickened mucosal folds, hypochlorhydria, and increased mucosal permeability that leaks serum proteins into the gastric lumen (A graphical summary of the pathogenesis and clinical features is illustrated in Supplementary Figure 1). By upgrading the methodology of previous descriptive summaries to a PRISMA-compliant systematic review, our study provides the most rigorous and comprehensive characterization of pediatric MD in the Chinese population to date.
Compared with reports from other regions, Chinese pediatric MD in this review showed both shared and distinctive characteristics. The shared features included male predominance, acute protein-losing gastropathy, and favorable response to supportive treatment. The distinctive pattern was the older median age at presentation/diagnosis (10.0 years), with more than half of the patients being school-aged children or adolescents and no infant cases identified. Western pediatric reports more often describe younger children, including toddlers and rare neonatal or infant cases, and more frequently emphasize CMV-associated disease (, –). This difference may reflect regional variation in infectious triggers, case ascertainment, reporting practices, and the availability of viral testing. Therefore, Chinese data should not be simply extrapolated from Western pediatric series, and multinational registries using standardized infectious and histological assessments are needed.
Clinically, pediatric MD profoundly diverges from its adult counterpart. Adult MD is a chronic, insidious disease with an 8.9% risk of malignant transformation, often necessitating EGFR inhibitors (e.g., Cetuximab) or gastrectomy (, ). In the aggregated cases, the core symptoms were acute abdominal pain, vomiting, and severe edema driven by profound hypoalbuminemia (median 20 g/L). Interestingly, we identified atypical presentations within the Chinese case aggregation, such as a patient presenting with isolated edema devoid of gastrointestinal symptoms. To contextualize this globally, recent international literature has also highlighted extreme atypical pediatric phenotypes, such as cases presenting primarily with gastric outlet obstruction due to polypoid mucosal prolapse (), or severe anasarca driven by acute CMV (). These diverse phenotypes underscore the critical need for pediatricians to include MD in the differential diagnosis for any unexplained hypoalbuminemia or anasarca, even in the absence of classic GI symptoms.
Internationally, while historical literature cited CMV implication in up to 70% of pediatric cases (), more recent studies suggest this proportion may be highly variable across different regions, though it remains the most prevalent trigger (). However, CMV positivity was documented in only 3 of the 16 aggregated cases (18.8%). This discrepancy is likely attributable to incomplete viral screening (e.g., lack of gastric tissue PCR or immunohistochemistry for CMV) in historical retrospective cases, leading to an underestimation of its true prevalence. Furthermore, Hp positivity was documented in 3 of the 16 aggregated cases (18.8%), which is lower than the general pediatric Hp prevalence globally (32.3%) and in China (29%) (, ), suggesting that Hp might be an incidental bystander rather than the primary driver of MD. Notably, one case in our review demonstrated EBV infection (EBER-positive), a novel finding scarcely reported internationally, hinting at a broader spectrum of viral triggers capable of initiating the TGF-α/EGFR cascade.
Diagnostic confirmation unequivocally relies on the convergence of clinical, endoscopic, and histopathological data. Endoscopically, the classic hallmark is the presence of giant, cerebriform gastric folds predominantly in the gastric body and fundus, with relative antral sparing. In the present case, although the antrum appeared endoscopically unremarkable, the gastric antral biopsy field showed foveolar/glandular hyperplasia with tortuous and branched glands but no convincing oxyntic mucosa in the displayed field; therefore, this field was interpreted cautiously rather than as definite oxyntic-type gland atrophy. Histologically, the characteristic pattern consists of foveolar hyperplasia with variable oxyntic gland atrophy when oxyntic mucosa is adequately sampled. Endoscopic ultrasound (EUS) is emerging as a valuable adjunct to assess the depth of mucosal thickening and to exclude submucosal malignancies like lymphoma ().
Therapeutically, pediatric MD is highly responsive to conservative management. All documented cases in the aggregated analysis achieved clinical improvement or remission with supportive care (albumin infusion, PPIs, and eradication of identified pathogens). The median time to symptom resolution was rapid (22 days), though morphological recovery visualized by endoscopy lagged significantly (median 4.5 months). While supportive care remains the mainstay, antiviral therapy (e.g., ganciclovir) may be considered in selected severe CMV-associated cases, particularly when ongoing protein loss necessitates repeated albumin replacement or when virological or histological evidence supports active CMV involvement (). Furthermore, the aggregated outcomes strongly affirm that, unlike the progressive adult phenotype, aggressive surgical interventions are unnecessary in most pediatric patients. Nevertheless, because chronic pediatric MD with gastric cancer has been reported exceptionally (), standardized follow-up until mucosal recovery remains clinically prudent.
The present institutional case adds to the literature by providing long-term follow-up to 6 years, documenting complete clinical and endoscopic recovery after conservative treatment, clarifying the histological interpretation of the gastric antral biopsy field, and integrating the case with all eligible Chinese pediatric reports under a PRISMA-based framework.
This study is constrained by its retrospective nature and the inherent limitations of systematically pooling case reports, which precludes calculating true incidence rates and introduces potential reporting bias. Future multicenter prospective registries utilizing standardized biopsy protocols and comprehensive viral genomic screening are imperative to fully decode the etiology and optimize the surveillance of pediatric MD.
Statements
Data availability statement
The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author.
Ethics statement
This study involving human data and tissue was approved by the Ethics Committee of Hebei Children’s Hospital (Approval No. 202222-66). The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin. Written informed consent was obtained from the individual(s), and minor(s)' legal guardian/next of kin, for the publication of any potentially identifiable images or data included in this article.
Author contributions
GL: Data curation, Formal analysis, Investigation, Writing – original draft. HF: Data curation, Formal analysis, Investigation, Writing – original draft. LC: Data curation, Investigation, Methodology, Writing – review & editing. XJ: Data curation, Investigation, Methodology, Writing – review & editing. WS: Data curation, Investigation, Methodology, Writing – review & editing. LW: Investigation, Validation, Visualization, Writing – review & editing. RZ: Conceptualization, Funding acquisition, Project administration, Supervision, Writing – review & editing.
Funding
The author(s) declared that financial support was received for this work and/or its publication. This work was supported by the Medical Science Research Project of Hebei (Grant No. 20231167). The funder had no role in the study design, data collection, analysis, interpretation of data, manuscript preparation, or decision to submit the manuscript for publication.
Conflict of interest
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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The author(s) declared that generative AI was not used in the creation of this manuscript.
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Supplementary material
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fped.2026.1896987/full#supplementary-material
Supplementary Table 1Baseline characteristics and clinical summary of 16 Chinese pediatric ménétrier disease patients.
Abbreviations
CARE, case report guidelines; CDI, clostridioides difficile infection; CMV, cytomegalovirus; CRP, C-reactive protein; CT, computed tomography; EBER, epstein-barr virus-encoded small RNA; EBV, epstein-Barr virus; EGFR, epidermal growth factor receptor; EUS, endoscopic ultrasound; H&E, hematoxylin and eosin; HAV, hepatitis A virus; HBV, hepatitis B virus; HCV, hepatitis C virus; HIV, human immunodeficiency virus; Hp, helicobacter pylori; HPF, high-power field; IQR, interquartile range; IVIG, intravenous immunoglobulin; JBI, Joanna Briggs institute; MD, ménétrier disease; PPI, proton pump inhibitor; PRISMA, preferred reporting Items for systematic reviews and meta-analyses; TB-DNA, tuberculosis DNA; TGF-α, transforming growth factor-alpha; WBC, white blood cell.
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Summary
Keywords
children, gastric mucosal hypertrophy, hypoalbuminemia, Ménétrier disease, PRISMA, systematic review
Citation
Li G, Fu H, Cheng L, Jia X, Shi W, Wang L and Zhao R (2026) Ménétrier disease in Chinese children: a case report and systematic review. Front. Pediatr. 14:1896987. doi: 10.3389/fped.2026.1896987
Received
01 June 2026
Revised
09 July 2026
Accepted
13 July 2026
Published
22 July 2026
Volume
14 - 2026
Edited by
Tudor Lucian Pop, University of Medicine and Pharmacy Iuliu Hatieganu, Romania
Reviewed by
Nilton Carlos Machado, Sao Paulo State University, Brazil
Anita Sejben, University of Szeged, Hungary
Updates
Copyright
© 2026 Li, Fu, Cheng, Jia, Shi, Wang and Zhao.
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*Correspondence: Ruiqin Zhao zhaoqin6610@outlook.com
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.