Gastritis is the term applied when inflammation of the stomach occurs. This condition is marked by epigastric pain or tenderness, nausea, vomiting with or without the presence of blood, and systemic electrolyte changes if vomiting persists. Hypertrophic is defined as an increase in the size of the different tissues composing a part. This diagnostic code refers to the tissue that makes up the gastric mucosa. Hypertrophic tissues of the gastric mucosa can be visualized by a gastroscope. This device consists of a tube and an optical system for observing the inside of the stomach. Other names for the condition of hypertrophic gastritis include lymphocytic (varioloform) gastritis and Menetrier's disease. The term varioloform refers to "pox-like" erosions on the mucosa.

The cause of lymphocytic (varioloform) gastritis is unknown. However, some cases occur in patients with a disease of the intestinal tract referred to as celiac sprue. Controversy exists as to whether Helicobacter (H) pylori infection may be a cause of lymphocytic gastritis. Hypertrophic gastritis may be caused by an autoimmune disorder.

Manifestations of conditions related to hypertropic gastritis are as follows:

• Lymphocytic (varioloform) gastritis- Signs and symptoms of the condition may include nonulcer dyspepsia and loss of gastric protein. Endoscopic and histologic findings may reveal an increase in intraepithelial lymphocytes and epithelium that is swollen and infiltrated with lymphocytes. Gastric erosions may be present. Bouts of abdominal pain, nausea and vomiting may occur. However, patients are often asymptomatic.

• Menetrier's disease - Most patients are middle-aged, and present with peripheral edema related to low blood proteins (hypoproteinemia). Some may show weight loss, anorexia, vomiting, abdominal pain, or diarrhea. In addition, there is an increase in thromboembolic disorders, pulmonary edema, and severe, recurrent infections. Hypoalbuminema is an additional result with decreased serum albumin concentrations present.

Diagnostic measures may include: gastroscopy; barium studies; mucosal tissue biopsy with cytology examination; and serum and blood laboratory examinations related to protein and albumin loss.

Treatment measures for conditions related to hypertropic gastritis are as follows:

• Lymphocytic (varoliform) gastritis - May be treated with corticosteroids or other medications.

• Menetrier's disease - Does not have a satisfactory treatment. If the condition starts in childhood, there may be a spontaneous remission. However, the theory is that the condition is then related to an allergy. Corticosteroids have met with some favorable response, and drugs to reduce protein loss and acid secretion have been somewhat effective. A high protein diet may be required for protein losses. There are reports of tissue improvement when H. pylori is treated.

Some cases of Menetrier's disease may require a partial or subtotal gastrectomy in order to prevent death from hypoproteinemia. T cell lymphoma of the intestines occurs in 10% of patients with celiac sprue. There is some association of this disease with lymphocytic gastritis.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1)) – Total plus 60% – Special Monthly Compensation (SMC).

• A complication of a number of diseases, including pernicious anemia.

• Rate the underlying condition.

• There are diseases of the digestive system, particularly within the abdomen, which, while differing in the site of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress or pain, anemia and disturbances in nutrition. Consequently, certain coexisting diseases in this area, as indicated in the instruction under the title “Diseases of the Digestive System,” do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding as outlined in 38 CFR 4.114 .  [38 CFR 4.113]

• Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. [38 CFR 4.114]