Thickened gastric folds are a common radiologic finding that can be produced by many unusual disorders. The imaging finding itself is so nonspecific that all of the various disorders cannot be distinguished by their radiologic appearance (see figures).

Ménétrier’s disease is a rare condition in which marked glandular hypertrophy of the stomach develops without any underlying cause. There is associated enlargement of the gastric rugae, hypochloremia, and hypoproteinemia. Despite the fact that there is often increased mucus secretion in the stomach, gastric acid output is reduced, which differentiates the disease from other types of hypertrophic gastritis in which acid output is often elevated. Protein-losing enteropathy is another distinguishing characteristic of Ménétrier’s disease. Patients often have pain, weight loss, vomiting, and diarrhea. According to the classic description of the disease, the hypertrophic fold changes occur only in the proximal stomach, but it is now known that the thickened folds can be seen throughout the stomach, including the antrum.

Spontaneous remission can occur, but often Ménétrier’s disease is a chronic recurrent illness that responds poorly to various therapies (e.g., antibiotics, H2 blockers). In severe cases, gastric resection may be required. There is controversy regarding whether the condition is premalignant. The prevailing thought is that it is not.

In a patient with peripheral eosinophilia and thickened gastric folds, eosinophilic gastritis should be strongly considered. There is often associated small bowel disease in patients with fold thickening. Sarcoidosis of the stomach may be more common than first appreciated; according to some reports, the condition can be identified in 10% of gastric biopsy specimens. With sarcoidosis, there is always associated pulmonary disease, and other portions of the GI tract may be involved. Both of these conditions respond dramatically to steroids, as do a few other gastric conditions.