Response to “Reassessing Ménétrier’s disease: diagnostic variability, molecular subtypes, and implications for precision therapy”

Dear Editor, We thank Chen and Lin for their thoughtful commentary on our narrative review of Ménétrier’s disease (MD).1,2 Their letter raises important methodological and biological considerations that merit detailed response and provide an opportunity to further contextualize our findings within the evolving understanding of this rare gastropathy. Chen and Lin correctly note that fewer than one-third of cases in our reviewed cohort included dual Helicobacter pylori and cytomegalovirus (CMV) testing, with nearly half lacking specialized staining. We acknowledge this limitation, which we explicitly addressed in our methodology section by emphasizing that only histopathologically confirmed cases were included to ensure diagnostic clarity. The heterogeneity in diagnostic approaches across case reports reflects the inherent challenges of synthesizing literature on a rare condition spanning four decades. As we discussed, the apparent decline in infection-associated MD may indeed reflect incomplete diagnostic assessment rather than a true epidemiological shift—a point we raised when comparing historical studies by Stolte et al.,3,4 which employed systematic multi-modal testing achieving greater than 95% sensitivity, with contemporary case reports utilizing variable and often incomplete testing protocols. We agree that standardized diagnostic criteria incorporating dual pathogen testing would strengthen future research and clinical practice.