What are some causes of gastric wall thickening?
Gastric wall thickening, also known as thickening of the gastric mucosa or gastric hypertrophy, can be caused by various medical conditions.
The gastric wall thickening is a diagnostic challenge for gastroenterologists and can be caused by a wide variety of benign and malignant disorders including lymphoma, adenocarcinoma, Menetriers’ disease, Crohn’s disease, peptic ulcer disease, sarcoidosis and tuberculosis.
Some of the common causes of gastric wall thickening include:
- Gastritis: Inflammation of the gastric mucosa can lead to gastric wall thickening. Gastritis can be caused by infection (Helicobacter pylori), long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol consumption, or autoimmune disorders.
- Peptic Ulcer Disease: Peptic ulcers are open sores that develop on the inner lining of the stomach or the upper part of the small intestine. Chronic peptic ulcers can cause thickening of the gastric wall.
- Gastric Cancer: Malignant tumors in the stomach can cause localized or diffuse thickening of the gastric wall. Gastric cancer can present as focal or circumferential thickening on imaging studies.
- Gastrointestinal Stromal Tumors (GIST): GISTs are rare tumors that can occur in the stomach. They can cause localized thickening of the gastric wall.
- Lymphoma: Primary gastric lymphoma is a type of cancer that originates in the stomach. It can lead to thickening of the gastric wall.
- Infiltrative Diseases: Certain infiltrative diseases, such as amyloidosis or sarcoidosis, can cause thickening of the gastric wall.
- Hypertrophic Gastropathy: This condition involves an overgrowth of the gastric mucosa, leading to thickening of the gastric wall. It can be associated with chronic gastritis or other underlying conditions.
- Eosinophilic Gastritis: This is an allergic condition where eosinophils (a type of white blood cell) accumulate in the gastric mucosa, causing inflammation and thickening.
- Portal Hypertension: Increased blood pressure in the portal vein (portal hypertension) can cause congestion and thickening of the gastric wall.
- Infections: Certain infections, such as tuberculosis or fungal infections, can cause thickening of the gastric wall.
The diagnosis of gastric wall thickening typically involves imaging studies, such as endoscopy, ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). Depending on the suspected cause, further tests, such as biopsies or blood tests, may be required for definitive diagnosis and appropriate management.
Gastritis and gastric malignancy are the most common causes of gastric wall thickening.
Gastritis can be acute or chronic and is caused by various etiologies including aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, tobacco, stress, trauma, burn injury, Crohn’s disease, or infection.
Of the various infectious etiologies, Helicobacter pylori is the most common cause of chronic gastritis.
Ménétrier’s disease is a rare idiopathic cause of gastric wall thickening and usually involves the gastric fundus and body.
Zollinger-Ellison syndrome (ZES) is related to increased gastric acid secretion and associated severe peptic ulcer disease caused by the increased secretion of the hormone gastrin by a gastrinoma or carcinoid tumor.
An important issue for the early diagnosis is the ability of CT to differentiate the gastric wall structure and the gastric wall thickness of pathological origins.
Increased wall thickness in CT may not always be a sign of malignancy. Gastric wall thickness may also increase due to benign reasons such as gastritis, ulcers, polyps, tuberculosis, Crohn’s disease, and Menetrier’s disease.
Early endoscopy and biopsy evaluations are required to conclude that the wall thickness is due to malignancy.
A case of diffuse gastric wall thickening that presented with long-standing chronic diarrhea and on evaluation was found to be having pancreatic gastrinoma.
A 50-year-old male was referred for evaluation of complaints of intermittent large volume diarrhea and nonbilious vomiting of 4 years duration.
During the episodes of diarrhea he used to pass large volume, watery stools but no blood or mucus. He had lost around 8 kg of weight over last 2 years. There was associated mild epigastric discomfort and occasional vomiting.
Physical examination was unremarkable.
He had been evaluated elsewhere and had normal complete blood counts, biochemistry, immunoglobulin A tissue transglutaminase serology and stool examination. Ultrasound of the abdomen was normal. An esophagogastroduodenoscopy showed thickened gastric folds with an inconclusive biopsy. However, the contrast enhanced computed tomography (CT) scan of the abdomen showed a hypodense mass lesion in the region of the uncinate process of the pancreas with thickened gastric walls.
Positron emission tomography-CT scan showed increased metabolic activity in the thickened gastric wall with active tracer uptake in the lesion in the uncinate process (SUVmax 10.6)
