Diagnostic Efficacy of the Secretin Stimulation Test for the Zollinger-Ellison Syndrome: An Intra-Individual Comparison Using Different Dosages in Patients and Controls

Kuiper, Patricia; Biemond, I.; Masclee, Ad; Jansen, J. B. M. J.; Verspaget, Hein W.; Lamers, C. B. H. W.

doi:10.1159/000265936

Cited by 6 publications

(2 citation statements)

References 14 publications

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“…To date, there have been a number of case reports and series describing false-positive rises in gastrin after secretin injection in patients who are achlorhydric from atrophic gastritis or proton pump inhibitor therapy 19,21-24 . However, no clinical studies have evaluated the frequency at which false-positive results occur.…”

Section: Introductionmentioning

confidence: 99%

Hypochlorhydria and Achlorhydria Are Associated With False-Positive Secretin Stimulation Testing for Zollinger-Ellison Syndrome

Shah

Singh²,

Yang³

et al. 2013

Pancreas

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Objectives Secretin stimulation testing (SST) is used to evaluate patients with hypergastrinemia in the diagnosis of Zollinger-Ellison syndrome (ZES). Case series have documented false-positive SST in patients with achlorhydria. This study reviews our experience with SST in hypo- and achlorhydric patients. Methods We examined 27 patients with hypo- or achlorhydria based on a predefined basal acid output (BAO) measurement of <5.0mEq/hour who also underwent SST for diagnosis of ZES. We report the frequency of false positive SST results in this setting. Results 330 patients underwent gastric analysis of which 27 had BAO<5.0mEq/hour and SST conducted. The mean fasting gastrin level was 247±304pg/mL and the mean BAO measurement was 1.6±1.8mEq/hour. Twenty patients were off and 7 were on anti-secretory therapy at time of testing. Four patients had false-positive SSTs; three with gastric atrophy (BAO=0mEq/hr) and one with drug-induced hypochlorhydria (BAO=0.5mEq/hr). These false-positive test results were confirmed by structural and functional imaging studies. Conclusions We have identified a 14.8% false-positive rate in SST in patients with hypo- or achlorhydria. Growing literature has identified severe consequences associated with discontinuing anti-secretory treatment for testing; therefore, SST will require interpretation in the setting of gastric acid suppression and needs to be interpreted in this context.

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Section: Introductionmentioning

confidence: 99%

Hypochlorhydria and Achlorhydria Are Associated With False-Positive Secretin Stimulation Testing for Zollinger-Ellison Syndrome

Shah

Singh²,

Yang³

et al. 2013

Pancreas

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“…One prospective study compared the SST results of patients without ZES on and off PPI (35). The authors reported similar false-positive rates of 39% for those on PPI versus 30% for those off PPI.…”

Section: Discussionmentioning

confidence: 99%

Validity of Secretin Stimulation Testing on Proton Pump Inhibitor Therapy for Diagnosis of Zollinger-Ellison Syndrome

et al. 2021

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INTRODUCTION: Zollinger-Ellison syndrome (ZES) is characterized by gastrinoma-induced hypergastrinemia causing excessive gastric acid secretion. Secretin stimulation tests (SSTs) are required for diagnosis in the majority of patients. Two case reports suggest that proton pump inhibitors (PPIs) cause false SST results. Consequently, PPIs are discontinued to allow hyperchlorhydria to recur; however, uncontrolled acidity can cause life-threatening complications in those with underlying undiagnosed ZES. The aim of this study was to determine whether PPIs influence the validity of SSTs for the diagnosis of ZES. METHODS: A retrospective chart review was performed. Charts of patients who underwent SSTs were reviewed to determine whether they were performed on or off PPI and the test's accuracy by comparing the results with gold standard tests (diagnostic laboratory testing performed off PPI or surgical pathology consistent with gastrinoma). Sensitivity, specificity, and positive predictive value (PPV) of SST on PPI were calculated and results compared with SST off PPI using noninferiority analyses. RESULTS: Twenty-eight patients corresponding to 29 SSTs were performed on PPI, and 70 patients corresponding to 107 SSTs were performed off PPI. Most of them were female and white and had multiple endocrine neoplasia type 1. We found no false-positive or false-negative SSTs on PPI. Sensitivity, specificity, and PPV of SSTs on PPI were determined to be noninferior to SSTs off PPI (P ≤ 0.05 for all). DISCUSSION: In our cohort, SSTs on PPI compared with SSTs off PPI were noninferior for sensitivity, specificity, and PPV. These results suggest that PPI withdrawal before SSTs may not be necessary.

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Multiple endocrine neoplasia type 1 (MEN-1) and neuroendocrine neoplasms (NENs)

Effraimidis

Knigge

Rossing

et al. 2022

Seminars in Cancer Biology

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Diagnostic Efficacy of the Secretin Stimulation Test for the Zollinger-Ellison Syndrome: An Intra-Individual Comparison Using Different Dosages in Patients and Controls

Cited by 6 publications

References 14 publications

Hypochlorhydria and Achlorhydria Are Associated With False-Positive Secretin Stimulation Testing for Zollinger-Ellison Syndrome

Hypochlorhydria and Achlorhydria Are Associated With False-Positive Secretin Stimulation Testing for Zollinger-Ellison Syndrome

Validity of Secretin Stimulation Testing on Proton Pump Inhibitor Therapy for Diagnosis of Zollinger-Ellison Syndrome

Multiple endocrine neoplasia type 1 (MEN-1) and neuroendocrine neoplasms (NENs)

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