Extensive peripheral edema disclosing lymphocytic gastritis: efficacy of omeprazole

Lymphocytic gastritis is characterized by intense lymphocytic infiltration of gastric epithelium. Excessive gastric protein loss is uncommon. We descr ibe the case of a 49-year-old white woman suffering from generalized edema and abdominal pain. She had severe serum hypoproteinemia, hypoalbuminemia a nd hypogammaglobulinemia. There was no renal cardiac or hepatic origin of p rotein loss, and no protein-losing enteropathy. Endoscopic examination show ed diffuse varioliform gastritis and histology confirmed lymphocytic gastri tis with > 30% intraepithelial lymphocytes without Helicobacter pylori. The protein loss stopped within two weeks of the beginning of omeprazole and e xtensive edema disappeared. Four years later, the patient was still free fr om edema. Inflammatory involvement of the gastric mucosa probably caused pr otein losing in this patient. Recognition of this exsudative gastropathy is important because long term remission is obtained with omeprazole.