Hypertrophic Gastric folds with Hypomagnesemia, linking the dots

  • Mansoor Zafar, Dr. Conquest Hospital, East Sussex Healthcare NHS Trust. https://orcid.org/0000-0001-8220-1014
  • Tila Muhammad, Dr. Conquest Hospital. East Sussex Healthcare NHS Trust.
  • Najam us Saher, Dr. Consultant and Assistant Professor.
  • Muhammad Toqeer, Dr. Conquest Hospital. East Sussex Healthcare NHS Trust.
Keywords: Oesophago-gastroduodenoscopy (OGD). Hypertrophic Gastric Polyps;, Hypomagnesemia;, Zollinger-Ellison Syndrome;, Multiple Endocrine Neoplasia type 1 (MEN1), Proton Pump Inhibitors (PPIs) ;

Abstract

A Caucasian man in early 80s was seen in Gastroenterology Clinic, following, referral from the Endocrinology Clinic for concerns for CT Abdomen requested for tiredness and weight loss of three kilograms. The patient also had microcytic picture with low MCV and Ferritin and hypomagnesemia. The CT suggested gross circumferential thickening of the wall of stomach with advice for invasive investigations to further characterise the CT findings. The Endoscopy suggested grossly enlarged rugae in the stomach, and enlarged gastric polyps. Patient was assured no new sinister abnormality.

Treatment challenges to consider were to stop acid suppression by prescribing Proton Pump Inhibitors (PPIs) which would lead to stomach ulcers, or to continue with PPIs with sequalae of worsening of hypertrophic gastric folds, enlarged gastric polyps and hypomagnesemia. It would be necessary to consider risk versus benefits in either situation to determine an appropriate treatment plan in the long term.

With background of Zollinger-Ellison Syndrome and MEN1 with heterozygous mutation with gastrinoma of the duodenum, and frailty he was advised to continue with Proton Pump Inhibitors with twice weekly correction of Magnesium infusions, and Iron tablets following Multi-disciplinary meeting.

doi: https://doi.org/10.12669/pjms.37.4.3984

How to cite this:
Zafar M, Muhammad T, Najam-us-Saher, Toqeer M. Hypertrophic Gastric folds with Hypomagnesemia, linking the dots. Pak J Med Sci. 2021;37(4):1237-1240. doi: https://doi.org/10.12669/pjms.37.4.3984

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Author Biographies

Mansoor Zafar, Dr., Conquest Hospital, East Sussex Healthcare NHS Trust.

MBBS. MRCP (UK).

Medical Registrar, General Internal Medicine - Gastroenterology.

General Internal Medicine (GIM) and Gastroenterology.

Tila Muhammad, Dr., Conquest Hospital. East Sussex Healthcare NHS Trust.

MBBS, FCPS (Medicine - Pakistan), MRCP (UK).

Consultant Gastroenterology, Conquest Hospital. East Sussex Healthcare NHS Trust

Najam us Saher, Dr., Consultant and Assistant Professor.

MBBS. FCPS (Dermatology- Pakistan).

Assistant Professor. Department of Dermatology.

Aga Khan University Hospital, Karachi, Pakistan. 74800.

Muhammad Toqeer, Dr., Conquest Hospital. East Sussex Healthcare NHS Trust.

MBBS, FCPS (Pakistan), MRCP (UK).

Consultant Gastroenterology, Conquest Hospital. East Sussex healthcare NHS Trust. TN37 7RD. United Kingdom. 

Published
2021-05-05
How to Cite
Zafar, M., Muhammad, T., Saher, N., & Toqeer, M. (2021). Hypertrophic Gastric folds with Hypomagnesemia, linking the dots. Pakistan Journal of Medical Sciences, 37(4). https://doi.org/10.12669/pjms.37.4.3984