Gastric Secretion in Ulcerogenic Tumors of the Pancreas

Ruppert, Richard D.; Greenberger, Norton J.; Beman, Floyd M.; Mccullough, Frank M.

doi:10.7326/0003-4819-67-4-808

Cited by 41 publications

(11 citation statements)

References 15 publications

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“…Normal or low gastric acid secretion in patients with enlarged gastric mucosal folds, as found in this study, is the rule (Spellberg andBaker, 1953, Fieber, 1955;Citrin et al, 1957, Strode, 1957Butz, 1960;Frank and Kern, 1967) (Grossman, Kirsner, and Gillespie, 1963;Fraser, Pitman, Lawrie, Smith, Forrest, and Rhodes, 1964;Krag, 1966;Ruppert, Greenberger, Beman, and McCullough, 1967;Zollinger and Moore, 1968;Bouchier, 1969).…”

Section: Follow Upsupporting

confidence: 64%

A study of six patients with hypertrophy of the gastric mucosa with particular reference to albumin metabolism

Jones¹,

Young²,

Morson³

et al. 1972

Gut

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SUMMARY Six patients with hypertrophy of the gastric mucosa (Menetrier's disease) have been studied. An incorrect diagnosis was initially made in four patients. The correct diagnosis was suggested by the appearances either of barium meal radiographs of the stomach or at gastroscopy. Estimates of both basal and maximal gastric acid secretion were within normal limits. A definitive histological diagnosis requires an adequate full-thickness biopsy of the wall of the stomach; a peroral gastric mucosal biopsy is of no value in this context. There was no evidence of premalignant change in the histological material available but five of the patients were shown to have concomitant superficial gastritis. Subtotal gastrectomy in four of the patients was followed by a striking amelioration of abdominal pain, which was only temporary in one patient.Albumin metabolism was studied in five of the patients, four of whom had concomitant superficial gastritis. None of the patients had hypoalbuminaemia. However, the fractional catabolic rate of albumin measured with ('3II)-albumin was shown in four of these patients to be increased, while the absolute catabolic rate was similar to that in control subjects. Similar results were obtained for albumin synthesis in three of the patients using the ('4C)-carbonate method. In two of the patients subtotal gastrectomy was associated with a marked reduction of the fractional catabolic rate of albumin and in one, using (125I)-fibrinogen,with a relatively less marked reduction in the fractional catabolic rate of fibrinogen. These results indicate that abnormal albumin metabolism can be demonstrated in patients with this syndrome in spite of normal plasma albumin concentrations. The detection of the abnormal albumin metabolism can be of diagnostic value in patients with this gastric lesion. The abnormalities of albumin metabolism found are consistent with excessive loss of albumin into the stomach and the presence of superficial gastritis could have contributed to protein loss. Menetrier (1888) described a syndrome characterized by marked oedema and ascites associated with grossly enlarged gastric mucosal folds. Since then there have been numerous reports of patients with similar lesions of the gastric mucosa, some of whom have also exhibited evidence of fluid retention. The concentrations of the plasma proteins, in particular albumin, when measured have tended to be low in these patients, especially when fluid retention was present (

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Section: Follow Upsupporting

confidence: 64%

A study of six patients with hypertrophy of the gastric mucosa with particular reference to albumin metabolism

Jones¹,

Young²,

Morson³

et al. 1972

Gut

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“…Fig. 5 shows that the highest false positive result of 34.7% was obtained in the duodenal ulcer patients on the criterion of BAC/MAC>0.6 recommended by Ruppert et al (1967). In Fig.…”

Section: Resultsmentioning

confidence: 99%

“…DISCUSSION Kaye et al (1970) expressed the view concerning the diagnostic value of gastric analysis that none of the criteria currently used for the diagnosis of the Zollinger-Ellison syndrome is entirely reliable in the differentiation of this syndrome from ordinary duodenal ulcer because of the overlap. They examined 3 criteria; namely, basal acid output>15 mEq/hr (Aoyagi and Summerskill 1966), ratio of basal to stimulated acid output>0.6 (Marks et al 1961), and ratio of basal to stimulated acid concentration>0.6 (Ruppert et al 1967). …”

Section: Resultsmentioning

confidence: 99%

“…Although it requires further confirmation by finding a high level of circulat ing gastrin, the diagnostic value of gastric analysis using certain criteria has been stressed for differentiating the Zollinger-Ellison syndrome from ordinary peptic ulcer (Marks et al 1961;Segal 1965; Aoyagi and Summerskill 1966;Ruppert et al 1967;Zollinger and Moore 1968). However, it has been pointed out that some of these criteria sometimes give false positive results in patients with duodenal ulcer (Kaye et al 1970), as well as false negative results in patients with the Zollinger-Ellison syndrome (Lewin et al 1973).…”

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confidence: 99%

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Significance of Gastric Analysis with Particular Reference to the Diagnosis of Zollinger-Ellison Syndrome

Ishimori

Miura

Sakurada

et al. 1975

Tohoku J. Exp. Med.

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“…However, radioimmunoassay of serum gastrin is not yet a routine analytical procedure and has to be limited to patients in whom the diagnosis of ZE syndrome is suspected clinically or because of secretory abnormalities. The various criteria based upon gastric secretion which have been proposed as a basis for making the diagnosis of the ZE syndrome include: a basal acid output equal to or greater than 15 mEq/h [I]; a basal acid concentration equal to or greater than 100 mEq/l [3]; a 12-hour nocturnal secretion exceeding 1.000 ml or 100 mEq [7]; a ratio between basal and stimulated acid concentration or between basal and stimulated acid output greater than 60% [10,12]. Study of the correlation between pepsin output and basal acid secretion is a supplementary biological test of use in the diagnosis of ZE syndrome [6],…”

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confidence: 99%

Discriminative Interest of the Study of Basal Acid Secretion and Pepsin Acid Correlation in Zollinger-Ellison Syndrome and Peptic Ulcer

Bernadès¹,

Mignon²,

Bensalem³

et al. 1973

Digestion

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Various criteria based upon study of basal acid and pepsin gastric secretion have been proposed to facilitate the diagnosis of Zollinger-Ellison (ZE) syndrome. These criteria have been analyzed on 599 gastric secretory studies on subjects who had undergone no gastric surgery. This population included 20 ZE syndromes and 495 duodenal ulcers (DU). Neither an acid concentration > 100 mEq/l nor an acid output > 15 mEq/h is sufficiently discriminatory for the diagnosis of ZE syndrome when taken alone because they were found in 8.2 and 6% of DU, respectively. However, the association of these two criteria in the same secretory study strongly increases the suspicion of this diagnosis because it was found in 60% of ZE syndrome cases and in only 2.8% of DU. A valuable modification of those criteria taken alone is the presence of a basal acid output > 18 mEq/h. In the present series, however, the most interesting criterion has proved to be a pepsin/acid correlation (K 25) equal to or lower than 35. In any case, a low pepsin/ acid correlation improves the suspicion of the diagnosis. The most characteristic secretory status of the ZE syndrome consists of an association of a basal acid output > 18 mEq/h, a basal acid concentration > 100 mEq/l and a K 25 < 35 which is found in 55% of ZE syndrome cases and in only 0.6% of DU without pyloric stenosis. These criteria have to be considered as a means of selection of patients in whom radioimmunoassay of serum gastrin is needed.

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Gastric Secretion in Ulcerogenic Tumors of the Pancreas

Cited by 41 publications

References 15 publications

A study of six patients with hypertrophy of the gastric mucosa with particular reference to albumin metabolism

A study of six patients with hypertrophy of the gastric mucosa with particular reference to albumin metabolism

Significance of Gastric Analysis with Particular Reference to the Diagnosis of Zollinger-Ellison Syndrome

Discriminative Interest of the Study of Basal Acid Secretion and Pepsin Acid Correlation in Zollinger-Ellison Syndrome and Peptic Ulcer

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