Peptic ulcer and gastric acid secretion in patients with insulinoma.

Abstract

We evaluated the incidence of associated peptic ulcers and the gastric acid secretion in our 20 series of insulinoma, and obtained the following results : 1) Four out of 20 patients (20%) with insulinoma were associated with peptic ulcers. 2) Except for the maximum acid concentration, the preoperative gastric secretion tests, such as the basal acid output and maximum acid output, failed to indicate hyperacidity in those patients. And patients with a short duration of illness by insulinoma neither showed hyperacidity nor were associated with peptic ulcers. 3) A tendency of reduced gastric acid secretion and the amelioration of peptic ulcers was observed in those who underwent the extirpation of insulinoma. 4) In the most recent case received gastric analysis with continuous monitoring of blood glucose level, an increase of basal acid output was observed during the hypoglycemic period in which the blood glucose levels reduced to around 30 mg/100 ml. These results indicate that the low blood glucose level and the high gastric acid secretion produced under the condition on an empty stomach, may be important factors related to the high association rates of the peptic ulcers in patients with insulinoma. -insulinoma : gastric acid secretion ; peptic ulcerIn patients with insulinoma, hypoglycemic attacks, caused by the exess amount of insulin from the pancreatic islet cell tumor, are frequently observed at hunger state. On the other hand, the intravenous injection of insulin is well known to be one of gastric secretion tests, in which stimulation of the vagus nerve induced by hypoglycemia results in the promotion of gastric secretion. Thereby, it is speculated that patients with insulinoma may have an high association rate of peptic ulcer due to the repeated gastric hypersecretions caused by hypoglycemic conditions. However, since the time that the conception of insulinoma was established (Whipple and Frantz 1935), there have been no reports referring the gastric secretion and the occurence of peptic ulcer in patients with insulinoma. From these viewpoints we studied patients with insulinoma who were operated on in our facility.

Peptic Ulcer Disease in Youths with Insulin-Dependent Diabetes Mellitus: A Prospective Study

“…One important factor is the number of hypoglycemic episodes the youth experiences, particularly under conditions of an empty stomach (e.g., during the night). Naito et al (1988) suggested that PUD might develop as a result of repeated episodes of hypoglycemia when the stomach is free of food, based on their findings of a hypersecretion of gastric acid under conditions of hypoglycemia in subjects with insulinomas and PUD. Two additional risk factors might include genotype (e.g., family history of PUD) and the amount and types of foods ingested.…”