“Folate-losing gastropathy” and intestinal folate absorption in patients with Ménétrier's disease (giant hypertrophic gastritis)

Abstract

The gastric loss of serum nonprotein components, such as vitamins has not been, to our knowledge, demonstrated in Ménétrier's disease (MD). The intestinal absorption and the gastric leakage of folic acid were investigated in 4 patients with documented MD; in each case there was an increased gastric clearance of plasma proteins as demonstrated by⁵¹Cr-labeled albumin tests. All the patients had a low serum level of folate and a flat curve of serum folate concentrations after an oral load of folic acid. The gastric loss of folate was determined in the patients and in 5 control subjects from the folate concentrations (before and after an intravenous injection of folinic acid) in basal and histamine-stimulated gastric secretion. A significant increase in concentrations and outputs of folate in gastric juice was observed in MD patients compared to controls, before as well as after gastric stimulation. None of the patients had abnormalities in jejunal morphology or in xylose absorption. The present study shows that folic acid should be added to the list of serum components which may be lost in excess into the gastric lumen in MD patients. The responsibility of this “folate-losing gastropathy” in the folate deficiency which may be observed in MD patients has to be discussed in relation to associated abnormalities in small-intestinal transport of folate.