Snap Shot A 44-year-old male presents to his primary care physician complaining of vague abdominal pain, nausea, and vomiting. He reports that he has noticed that his shoes no longer seem to fit and wonders if he might have venous insufficiency. Hemoccult stool is positive. Introduction Hypertrophic gastropathy secondary to hyperplasia of mucus-producing cells Increased mucin production leads to protein loss Little or no acid production aka hypoproteinemic hypertrophic gastropathy Rare acquired premalignant stomach disease Associated with H. pylori and CMV infections Caused by hypoproteinemia Etiology unknown, but pathophysiology linked to epidermal growth factor receptor (EGFR) ligand Presentation Symptoms abdominal pain nausea emesis anorexia weight loss occult gastric bleed Physical exam nonspecific abdominal pain edema (from protein/albumin losses) Evaluation Endoscopy with deep mucosal biopsy Gross appearance giant rugal folds Microscopic appearance atrophy of parietal cells Labs hypoalbuminemia increased TGF-α Treatment Medical management no consensus on management possible therapies have included: steroids anticholinergics acid suppression octreotide cetuximab neutralizing monoclonal antibody against EGFR Surgery reserved for patients with intractable symptoms or high-risk of progression to cancer total gastrectomy subtotal gastrectomy Prognosis, Prevention, and Complications ↑ risk of adenocarcinoma anastomotic leak and fistula is problem with subtotal gastrectomy